Annexure – 9 From NY volunteer to District NYK

COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019

Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.

Name of NY Volunteers …………………………. Name of allotted Block(s)……………………………… Progress Report for the month ……………………………………..

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where progs. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

1. Linking Youth Club Members with Employable Skill Development Trainings

No. of Youth

2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others

No. of villagers

3. Creation of new Water Bodies No. of Water Bodies

4. Maintenance/ repair/ improvement of existing Water Bodies

No. of water bodies

5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.

Number

6. Maintenance & repair of Cremation Grounds and Play Grounds

Number

7. Recharging / De-silting of Wells Number

8. Water Harvesting in Villages Number

9. Construction of Bori Badas in a Village Number

10. Agriculture Land Soil Cards Number

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where progs. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

11. Selection of Swachhta Ambassadors at Block, District & State level

No. of Ambassadors

12. Chain of Ambassadors Number

13. Cleanliness of School/College No. of Schools/ Colleges

14. Cleanliness PHC/Sub Center/Hospitals Number

15. Cleanliness Drive to clean streets and common places

Number

16. Cleaning of office complex, toilets and garbage places of district & state offices

Number

17. Cleanliness Public Statues Number

18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)

No. of Toilets

19. Sapling Plantation and their survival No. of Plants

20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment

No. of Villages

21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages

No. of Villages

22. Blood Donation No. of Youth donated blood

23. Enrollment of Voluntary Blood Donors and their Blood Grouping

No. of Youth

24. Providing access of Iron Folic Acid Tablet to Adolescent Girls

No. of Adolescent Girls

25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.

No. of Girls

26. Motivate and Facilitated Institutionalized Deliveries

No. of Women

27. Immunization of Pregnant Mothers No. of Pregnant Mothers

28. Motivate and Immunization of Children (0-5 yrs)

No. of Children

29. Cataract (Eye) operations No. of Persons

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where progs. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)

No. of Camps

31. Enrollment of children in schools No. of Children

32. Beti Bachao - Beti Padhao Number

33. Facilitating into getting Voters ID Cards No. of Persons

34. Training in Cashless Transaction to Youth Leaders

No. of Persons

35. Other Programmes as per local need and priority may please be added in the Plan with targets

** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct

Signature

NY volunteer with Office Stamp

Name:……………………………..

Block:……………………………..

Note : Please use the same proforma. Date :……………………………...

Annexure – 9 A

From District NYK to State Office

COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019

Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.

Name of District Youth Coordinator ………………No. of Blocks in the District………………No. of NY Volunteers………………………….Progress Report for the month ………………………

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where prog. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

1. Linking Youth Club Members with Employable Skill Development Trainings

No. of Youth

2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others

No. of villagers

3. Creation of new Water Bodies No. of Water Bodies

4. Maintenance/ repair/improvement of

existing Water Bodies

No. of water bodies

5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.

Number

6. Maintenance & repair of Cremation Grounds and Play Grounds

Number

7. Recharging / De-silting of Wells Number

8. Water Harvesting in Villages Number

9. Construction of Bori Badas in a Village

Number

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where prog. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

10. Agriculture Land Soil Cards Number

11. Selection of Swachhta Ambassadors at Block, District & State level

No. of Ambassadors

12. Chain of Ambassadors Number

13. Cleanliness of School/College No. of Schools/ Colleges

14. Cleanliness PHC/Sub Center/Hospitals

Number

15. Cleanliness Drive to clean streets and common places

Number

16. Cleaning of office complex, toilets and garbage places of district & state offices

Number

17. Cleanliness Public Statues Number

18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)

No. of Toilets

19. Sapling Plantation and their survival No. of Plants

20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment

No. of Villages

21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages

No. of Villages

22. Blood Donation No. of Youth donated blood

23. Enrollment of Voluntary Blood Donors and their Blood Grouping

No. of Youth

24. Providing access of Iron Folic Acid Tablet to Adolescent Girls

No. of Adolescent Girls

25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.

No. of Girls

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

Name of collaborating agency / deptts.

No. of place/ village where prog. organized

Name & Designation of VIPs and dignitaries attended prog.**

No. of Days Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

26. Motivate and Facilitated Institutionalized Deliveries

No. of Women

27. Immunization of Pregnant Mothers No. of Pregnant Mothers

28. Motivate and Immunization of Children (0-5 yrs)

No. of Children

29. Cataract (Eye) operations No. of Persons

30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)

No. of Camps

31. Enrollment of children in schools

No. of Children

32. Beti Bachao - Beti Padhao Number

33. Facilitating into getting Voters ID Cards

No. of Persons

34. Training in Cashless Transaction to Youth Leaders

No. of Persons

35. Other Programmes as per local need and priority may please be added in the Plan with targets

** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct

Note : Please use the same proforma. Signature

Name:……………………………….

District Youth Coordinator with Office Stamp Prepared by ACT: Name and Signature ……………………………………………

Date ________________________ Date:………………………………..

Annexure – 9 B From District NYK to State Office

COORDINATION PROGRAMME (Cumulative Progress Report) 2018-2019

Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.

Name of District Youth Coordinator …………………………. No. of Blocks in the District………………No. of NY Volunteers…………………Progress Report for the Period …………………

S.No. Name of the prog. organized Prog. Unit No. of

Youth Clubs involved

No. of place/ village where progs. organized

No. of Days

Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

1. Linking Youth Club Members with Employable Skill Development Trainings

No. of Youth

2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others

No. of villagers

3. Creation of new Water Bodies No. of Water Bodies

4. Maintenance/ repair/improvement of existing Water Bodies

No. of water bodies

5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.

Number

6. Maintenance & repair of Cremation Grounds and Play Grounds

Number

7. Recharging / De-silting of Wells Number

8. Water Harvesting in Villages Number

9. Construction of Bori Badas in a Village

Number

10. Agriculture Land Soil Cards Number

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days

Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

11. Selection of Swachhta Ambassadors at Block, District & State level

No. of Ambassadors

12. Chain of Ambassadors Number

13. Cleanliness of School/College No. of Schools/ Colleges

14. Cleanliness PHC/Sub Center/Hospitals

Number

15. Cleanliness Drive to clean streets and common places

Number

16. Cleaning of office complex, toilets and garbage places of district & state offices

Number

17. Cleanliness Public Statues Number

18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)

No. of Toilets

19. Sapling Plantation and their survival No. of Plants

20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment

No. of Villages

21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages

No. of Villages

22. Blood Donation No. of Youth donated blood

23. Enrollment of Voluntary Blood Donors and their Blood Grouping

No. of Youth

24. Providing access of Iron Folic Acid Tablet to Adolescent Girls

No. of Adolescent Girls

25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.

No. of Girls

26. Motivate and Facilitated Institutionalized Deliveries

No. of Women

27. Immunization of Pregnant Mothers No. of Pregnant Mothers

28. Motivate and Immunization of Children (0-5 yrs)

No. of Children

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days

Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

29. Cataract (Eye) operations No. of Persons

30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)

No. of Camps

31. Enrollment of children in schools No. of Children

32. Beti Bachao - Beti Padhao Number

33. Facilitating into getting Voters ID Cards

No. of Persons

34. Training in Cashless Transaction to Youth Leaders

No. of Persons

35. Other Programmes as per local need and priority may please be added in the Plan with targets

** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct

Note : Please use the same proforma. Signature

Name:………………………………

District Youth Coordinator with Office Stamp Prepared by ACT: Name and Signature ……………………………………………

Date ________________________ Date:…………………………………….

Annexure – 9 C From State Office to NYKS, Hqr.

COORDINATION PROGRAMME (Monthly Progress Report) 2018-2019

Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.

Name of State Director …………………………..No. of District NYKs……………No. of Blocks……………….No. of NY Volunteers…………Progress Report for the month ………………………

S.No. Name of the Prog. organized Prog. Unit No. of

Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

1. Linking Youth Club Members with Employable Skill Development Trainings

No. of Youth

2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others

No. of villagers

3. Creation of new Water Bodies No. of Water Bodies

4. Maintenance/ repair/improvement of existing Water Bodies

No. of water bodies

5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.

Number

6. Maintenance & repair of Cremation Grounds and Play Grounds

Number

7. Recharging / De-silting of Wells Number

S.No. Name of the Prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

8. Water Harvesting in Villages Number

9. Construction of Bori Badas in a Village

Number

10. Agriculture Land Soil Cards Number

11. Selection of Swachhta Ambassadors at Block, District & State level

No. of Ambassadors

12. Chain of Ambassadors Number

13. Cleanliness of School/College No. of Schools/ Colleges

14. Cleanliness PHC/Sub Center/Hospitals

Number

15. Cleanliness Drive to clean streets and common places

Number

16. Cleaning of office complex, toilets and garbage places of district & state offices

Number

17. Cleanliness Public Statues Number

18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)

No. of Toilets

19. Sapling Plantation and their survival No. of Plants

20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment

No. of Villages

21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages

No. of Villages

22. Blood Donation No. of Youth donated blood

23. Enrollment of Voluntary Blood Donors and their Blood Grouping

No. of Youth

24. Providing access of Iron Folic Acid Tablet to Adolescent Girls

No. of Adolescent Girls

25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.

No. of Girls

26. Motivate and Facilitated Institutionalized Deliveries

No. of Women

S.No. Name of the Prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

27. Immunization of Pregnant Mothers No. of Pregnant Mothers

28. Motivate and Immunization of Children (0-5 yrs)

No. of Children

29. Cataract (Eye) operations No. of Persons

30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)

No. of Camps

31. Enrollment of children in schools No. of Children

32. Beti Bachao - Beti Padhao Number

33. Facilitating into getting Voters ID Cards

No. of Persons

34. Training in Cashless Transaction to Youth Leaders

No. of Persons

35. Other Programmes as per local need and priority may please be added in the Plan with targets

** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct Note : Please use the same proforma. Signature

Name:………………………………

State Director with Office Stamp

Date:………………………………..

Prepared by Dealing Hand: Name & Signature ………………………………………

Date ________________________

Annexure – 9 D

From State Office to NYKS, Hqr.

COORDINATION PROGRAMME (Cumulative Progress Report) 2018-2019

Programmes other than NYKS Core Programmes, organized in coordination with other Departments and Agencies by raising local resources and funds.

Name of State Director ………………………No. of District NYKs………………No. of Blocks………………No. of NY Volunteers…………………Progress Report for the Period ……………………

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

1. Linking Youth Club Members with Employable Skill Development Trainings

No. of Youth

2. Promotion & Facilitating Villagers to get benefits under Prime Minister Financial Inclusion Schemes (Pradhan Mantri Jan Dhan Account, benefit under Pradhan Mantri Suraksha Beema Yojna, Pradhan Mantri Jeevan Jyoti Yojna, Atal Pension Yojna, MUDRA Bank (Micro Units Development and Re-finance Agency), Pradhan Mantri Fasal Bima Yojana, Digital India, Make in India - Skill India, Start up India, Stand up India and others

No. of villagers

3. Creation of new Water Bodies No. of Water Bodies

4. Maintenance/ repair/improvement of

existing Water Bodies

No. of water bodies

5. Cleaning, Digging,, Maintenance , De-silting and repair of Ponds, natural drinking water resources, small irrigation channels, water tanks, etc.

Number

6. Maintenance & repair of Cremation Grounds and Play Grounds

Number

7. Recharging / De-silting of Wells Number

8. Water Harvesting in Villages Number

9. Construction of Bori Badas in a Village

Number

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

10. Agriculture Land Soil Cards Number

11. Selection of Swachhta Ambassadors at Block, District & State level

No. of Ambassadors

12. Chain of Ambassadors Number

13. Cleanliness of School/College No. of Schools/ Colleges

14. Cleanliness PHC/Sub Center/Hospitals

Number

15. Cleanliness Drive to clean streets and common places

Number

16. Cleaning of office complex, toilets and garbage places of district & state offices

Number

17. Cleanliness Public Statues Number

18. Motivation resulting into Construction of Toilets for Open Defecation Free (ODF)

No. of Toilets

19. Sapling Plantation and their survival No. of Plants

20. Collection of Polythene Bags to generate awareness and facilitate in protecting environment

No. of Villages

21. Eradication of weeds e.g. (Gajar Ghas, Lantana, Water Hyacinth) in villages

No. of Villages

22. Blood Donation No. of Youth donated blood

23. Enrollment of Voluntary Blood Donors and their Blood Grouping

No. of Youth

24. Providing access of Iron Folic Acid Tablet to Adolescent Girls

No. of Adolescent Girls

25. Motivated Girls and their Parents to postpone her marriage till attaining 18 yrs.

No. of Girls

26. Motivate and Facilitated Institutionalized Deliveries

No. of Women

27. Immunization of Pregnant Mothers No. of Pregnant Mothers

S.No. Name of the prog. organized Prog. Unit No. of Youth Clubs involved

No. of place/ village where progs. organized

No. of Days Name of collaborating agency / deptts.

Name & Designation of VIPs and dignitaries attended prog.**

Resource Mobilization Physical Number of Participants / Beneficiaries

Funds raised for activity ( in Rs.)

No. of Resource Persons, Trainers and Experts invited

Material, Equipments, Transport, etc.

Target (Annual)

Achieved SC ST Minority OBC Gen. Total

M F M F M F M F M F M F

28. Motivate and Immunization of Children (0-5 yrs)

No. of Children

29. Cataract (Eye) operations No. of Persons

30. Health Check-up Camps (DOTs, Hypertension, Diabetics and others)

No. of Camps

31. Enrollment of children in schools No. of Children

32. Beti Bachao - Beti Padhao Number

33. Facilitating into getting Voters ID Cards

No. of Persons

34. Training in Cashless Transaction to Youth Leaders

No. of Persons

35. Other Programmes as per local need and priority may please be added in the Plan with targets

** Please convert the resource mobilization obtained in kind, equipments, transport, human resource, etc. into amount as per state/ local market rate. ** Enclose one page write-up (neatly typed) for each project mentioned above separately with press clippings and action photographs. ** VIPs and Dignitaries (Hon’ble Ministers, MPs, MLAs, Heads of PRIs, Officers of Development Departments, Agencies, District Administration, etc. ** Certified that the report given above and fund and resource mobilization information is true and correct

Note : Please use the same proforma. Signature

Name:……………………………….

Prepared by Dealing Hand: Name & Signature ……………………………………… State Director with Office Stamp

Date ________________________ Date:………………………………..