International Science Community Association
International Girl Empowerment Award
The International Girl Empowerment Award was established in the year 2015 by
International Science Community Association to honour and recognize the Personnel who
have made significant fundamental contributions in girl empowerment and whose efforts
have marked an impact to society over a sustained period of years.
General terms and Conditions

Nominee Male/female should be an International Science Community Association
Fellow Contributor.

Main criteria for the award are based on contributions to the society aiming of
upliftment of girl / girl child.

The evaluation sheet must be filled properly and each claim should be supported by the
document failing with that the award would not be considered.

Last date to receive the completed nomination forms is 30th September 2016.

Incomplete applications will be rejected without any further notice.
Complete Applications (one printed copies + a soft copy as a single folder on CD)
shall be submitted to:
Director,
International Science Community Association,
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA.
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005, MP, INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
International Science Community Association
International Girl Empowerment Award
NOMINATION FORM 1A NOMINEE’S PARTICULARS
(In capital letters please)
Photo
Title
First Name
Middle Name
Last Name
Name
International Science Community Association Fellow Contributorship no.____________________________
Date of Birth
______________________________________________________________
Residential Phone No.
______________________________________________________________
Mobile No.
______________________________________________________________
Address
______________________________________________________________
______________________________________________________________
City __________________ Pin Code ____________ State ______________
E-mail ID
______________________________________________________________
Personal Website
______________________________________________________________
Institute
______________________________________________________________
Current designation/Position _____________________Type of Institute (Govt./Auto./Others) ___________
Address
______________________________________________________________
______________________________________________________________
City __________________ Pin Code ____________ State ______________
Phone Number
______________________________________________________________
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005, MP, INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
International Science Community Association
International Girl Empowerment Award
NOMINATION FORM 1B
(Attach separate sheets wherever required)
1. More about you : Introduce yourself 200-300 words
(You can include your hobbies, areas of interests etc.)
2. Why did you choose this field of Girl Empowerment?
3. Mention the challenges you came across and how did you overcome it.
(Explain the challenges you faced on the below mentioned points)
i.
ii.
iii.
iv.
v.
vi.
Self
Family
Society
Profession
Legal Challenges
Others
4. What was the inspiration and who is your role model behind joining the campaign of Girl
Empowerment.
5. How do you feel your inputs or efforts are transforming society towards girl / girl child.
6. Achievements
(Please specify the recognitions you have gained during this campaigning)
i. News Papers
ii. Certifications
iii. Awards
iv. Others
7. What means and measures / steps were taken by you to achieve the goal of Girl
Empowerment?
i. Organised
a) Workshops b) Counselling sessions c) Camps d) Seminars e) others.
ii. Sponsorship for education or upliftment of girl.
iii. Association with NGO or other societies.
iv. Others.
I certify that the information provided above is accurate. I allow the committee of this competition to use my
information and photographs for the websites, advertise, brochures and other promotional collaterals in
relation to the International Girl Empowerment Award 2016. I will abide by the competition rules and
regulations and respect the final decision arrived at by the esteemed judging panels.
Signature of Applicant.............................
Date......................................................
Place......................................................
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005, MP, INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in