Svayam- National Centre for Inclusive Environments

(an initiative of S.J. Charitable Trust)

Jindal Centre, 12 Bhikaiji Cama Place, New Delhi- 110066

Tel.: 011-41462323, 41462080 Fax: 011-26105671

Email: ;

NOMINATION FORM

Svayam Accessibility Awards 2015

CATEGORIES: Public Transport / Hospitality/ Tourist Attraction/ Heritage Site

DETAILS OF THE NOMINEE:

Name of the Organisation nominated:
Name of the Contact person with designation:
Address with Pin Code:
Telephone No. with Extn: / Fax No.:
E-mail:
Alternate Email: / Website, if any:
Date of Establishment of the organisation:
Specific area of work:
Important Milestones achieved by organisation:
Total number of employees: / Total number of Employees with Disabilities:
Orthopedically disabled: / Visually Impaired/Blind: / Hearing Disabled:
Nominated under category: Public Transport / Municipality / Hospitality/ Tourist Attraction
Awards in various categories as above will be given to those organisations (both from Government/ Private sector including municipalities, panchayats, PSUs, PPP models and NGOs, proprietorship firms, etc. )who have taken up initiatives to make their built environment, infrastructure and services (including information and communication technology, consumer products, assistive technology etc.) accessible to all irrespective of their abilities, gender, size, language, culture, and especially the persons with disabilities, children and seniors.
The awards are an attempt to recognise their efforts and encourage them the awardees to reach their highest potential to ensure universal accessibility for all. This is also to encourage other organisations to be in pursuit of achieving universal access in their infrastructure, products and services that leads to making a community liveable for all.
(1)Synopsis of the work done (specific to ensure accessibility and universal design in infrastructure/ services, products etc ): Please attached along with the form necessary documents in support of the claim, e.g. videos, photos, citations, new reports, media coverage etc to help the Award Committee make a selection.
Details of any other awards / recognition received:

Note: The Screening Committee or the Jury of Experts may seek such further information / documents/ evidence as may necessary to verify the claims made in the application / nomination form. Such information must be provided by the applicant/ nominator as the case may be on priority to facilitate the Jury to take arrive at a final decision.

DETAILS OF THE NOMINATOR, if different from the NOMINEE Organization:

Name:
Job Title / Designation:
Name of the Organisation:
Address:
Telephone No.: Fax No.:
E-mail
Details of the association of the nominator with the organisation nominated:
Your perception of the future role of the organisation that you have nominated with regard to the promotion of accessibility:
State briefly your reasons for nominating theorganisation:
An undertaking from the Executive Head of the nominated organisation that it would agree to accept & receive the award, if selected by the Jury and provide such further information as may be required to verify/ support the claims made.
Date: Signature

Thank you for helping identify a possible role model. We will be grateful if you could please email/ courier this Nomination Form before the closing date given in the announcement.

NOMINATION FORM: Svayam Accessibility Awards 2015