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Nomination Form

Nomination Form

Sant Eshwer Samman 2024 form

Please select the category of nominee: *

IndividualOrganizationGroup of People

Nominee Name *

Contact number *

Designation

Organization Name

Address (Including Village and District) *

State *

Email Id *

Website

Alternate Contact No/ Landline No *

Please select the relevant area of operation: *

Tribal AreaRural AreaWomen and Child DevelopmentSpecial Contribution (Environment, Literature, Research, Culture etc)

Brief description of nominee's work (500 words) *

Detailed description of their achievements: Rationale for Nomination (1000 words) *

Describe the difficulties and struggles faced by the nominee (500 words)

What thought or incident inspired/motivated the nominee to work in this area (500 words) *

Describe the impact of the nominee's work on society (short term) (in 500 words) *

Describe the impact of the nominee's work on society (long term) (in 500 words) *

Any other information about the nominee that you want to share

Details of donation/financial aid/ FCRA received for the work

Please provide details of any award / honor received by the nominee

Is there is any economic irregularity, moral allegation or lawsuit against the nominee? *YesNo

If yes, please provide details

Name *

Contact number *

Organization Name *

Designation *

Email id *

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