Nomination Form 2024 – Rohini Nayyar Prize

Nominate yourself or someone you know for Rohini Nayyar Prize

Nomination form

Nomination form for Rohini Nayyar Prize

Please ensure that you have read about the Rohini Nayyar Prize and are aware of the terms and conditions before filling and submitting the nomination.

Nomination form for Rohini Nayyar Prize

Please ensure that you have read about the Rohini Nayyar Prize and are aware of the terms and conditions before filling and submitting the nomination.

The last date for submission is 15th August, 2023.

Name (of nominee) *

First

Last

Photo (of nominee) *

Click or drag a file to this area to upload.

Date of Birth *

Proof of Age (Aadhar Card/ Voter ID/ Class X certificate) *

Click or drag a file to this area to upload.

Address for Communication (City, Street, State, Pin Code) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Mobile No. *

Alternative Mobile No.

Website / Social media links (of nominee)

Are you Self Nominating? Please note that if you work in an organization of which you are not the Founder or CEO, the head of your organization should be your nominator. If not, you can self-nominate If the response is No, or if you work in an organization of which you are not the Founder or CEO: *

Occupation, Organisation and Designation of Nominator

In what capacity, and for how long, has the Nominator known the Nominee

Please provide the names of two referees who are familiar with your work

Referee 1
Referee 2

Work / Impact Related Questions

Question 1: Specify the precise location of the nominee’s work: village, block, sub-division, district and State ( Maximum 75 words)

Question 2: Describe the nominee's work? (Maximum 250 Words)

Question 3: Describe how the nominee has contributed to one or more aspects of rural development, including climate-action, environmental-conservation, bio-diversity, energy, food-systems, agriculture, education, health, water, sanitation, enterprise development, employment-creation, women’s empowerment, child development, micro-finance, and related activities.(maximum 250 words). *

Question 4: Describe how the nominee's work satisfies one or more of the following two criteria (Maximum 250 words): (a) Innovative work which is ahead of the curve, including the use of emerging technologies, or brings about a change in social norms and community behaviour, or (b) Impactful work, which is sustained, whether extensive (affecting many people in larger geographical spaces), or intensive (major transformative change in a small community). *

Nomination form

Nomination form for Rohini Nayyar Prize

Nomination form for Rohini Nayyar Prize

If the response is No, or if you work in an organization of which you are not the Founder or CEO:

Referee 1

Referee 2

Work / Impact Related Questions

Quick Links

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