Part - I Key Details
Category : Theme :
if others, pl specify:
Type of Environment Communication Initiative :
if others, pl specify:
Funded By :
Initiative Title :
Initiative Start Date : Initiative End Date :
Part - II Description
Initiative Purpose and Goals : Description
(Please describe in max 250 words the initiative)
Target Audience
(Please mention the initiative target group)
: Medium Used :

if others, pl specify:
Activity Details
(Frequency and duration if print or electronic media used)
: Achievements, Outcomes and Impact considering the evaluation criteria
(Achievements: Extent to which initiative goals were achieved; Outcome: Results of initiative implementation; Impact: Initiative influence on target audience)
(Submit outreach data, if any, kindly attach relevant documents i.e. activity reports, ppts, documentation, collaterals etc in Part III)
(How initiative has been sustainable over the years and future sustainability)
: Elaborate why your entry is a game changer?
(Is it innovative? Can it help sensitise & engender positive behaviours? Has it galvanised responsible action for a sustainable future? Kindly attach relevant documents, testimonials etc. if any, to show change effected by initiative in part III).
Part - III Documents (upload here)
(Max 4 photos can be uploaded in jpeg, png and gif formats only)
: News Coverage
(Max 4 news clippings can be uploaded in jpeg, png and gif formats only)
(Please paste the film link here i.e. YouTube or Vimeo, etc)
: Audios
(Please paste the sound cloud link etc.)
Other Documents
(Max 4 Collaterals, PPT, Report or other documentation)
: Full Name of Awardee
(As it should appear in the citation and trophy, if awarded)
Part - IV Entrant Details
Name : Designation :
Organisation : Address :
Gender : City :
State : Country :
PIN Code : Mobile :
Phone : Fax :
Email : Website :

Entry Type Date Fee
Early Bird Thursday, September 15, 2016 FREE
Final Call For Entry Saturday, October 15, 2016 INR 1000
GALA AWARD NITE: Friday, February 17, 2017

I hereby confirm that the particulars provided above are true to the best of my knowledge. I am also the authorised representative/ person to apply for this award.