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Gopal – Kamala Rajbhandari Rotary Award for WASH (Water and Sanitation)

Please read the details carefully. The nomination; • Must be submitted on this form • Must be typewritten •May not exceed the space provided

NOMINATION FORM

GOPAL – KAMALA RAJBHANDARI ROTARY AWARD FOR WASH (WATER AND SANITATION)

A Nominee

Individual

Your Name
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email

Group of Individuals

1. Your Name
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email
2. Your Name
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email
3. Your Name
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email

Organization

if the group consists of more than 3 individuals use a separate sheet.
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email

B Nominator

Your Name
Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email
MM slash DD slash YYYY

Organization

Address
District
Municipality
Tole/Locality
Contacts
Telephone
Cell
Email
MM slash DD slash YYYY
Office Seal
Accepted file types: jpg, jpeg, png, gif.
This field is for validation purposes and should be left unchanged.

C Background and Experience

1. Provide a brief introduction about the Candidate(s)/Organization. (Max 300 words)

2. Describe the experience and involvement of the Candidate(s)/Organization in WASH-based vocations. (Max 300 words)

3. How many years has the Candidate(s)/Organization been engaged in this field?

D Contributions and Achievements

1. Describe the specific contributions made by the Candidate(s)/Organization in WASH-based vocations that have positively impacted society. (Max 500 words)

2. How do these efforts reflect the Rotary motto, ‘Service Above Self’? (Max 300 words)

3. Describe any innovations, creative solutions, or risks taken by the Candidate(s)/Organization to advance WASH or support communities. (Max 300 words)

4. How have these efforts helped improve the quality of life for others? Please provide specific examples. (Max 300 words)

5. Has the Candidate(s)/Organization received any awards, recognitions, or acknowledgments for their work? If yes, please provide details.

E Impact and Sustainability

1. What measurable impact has the work of the Candidate(s)/Organization had on the community? (e.g., number of people benefited, land rehabilitated, employment created, etc.) (Max 300 words)

2. How has the work of the Candidate(s)/Organization inspired or motivated others to take action in the field of WASH? (Max 300 words)

3. What challenges have been faced, and how have they been overcome? (Max 300 words)

4. How does the Candidate(s)/Organization plan to sustain and expand its contributions in the future? (Max 300 words)

5. If the Candidate(s)/Organization receives this award, how will the cash prize of NPR 2,000,000 be utilized to further contribute to WASH -based vocations? (Max 300 words)

Please return this form to:
Rotary International District 3292
Rotary District Office,
Rotary Hall, Thapathali, Kathmandu, Nepal
Tel: 01 5355344, email: rotary@ntc.net.np/rotary3292@yahoo.comEligibility Criteria for

GOPAL – KAMALA RAJBHANDARI ROTARY AWARD FOR VOCATIONAL EXCELLENCE (GKRRA VE)

The Award

The award has been instituted by Rotary International District 3292 which consists of a letter of citation and a cash award of Rupees 2,000,000.00 (Two million Rupees).

Objective

The main objective of this award is to recognize an individual, a group of individuals or an organization for outstanding achievement as young entrepreneur in the field of his/her/its chosen profession in a selfless and dedicated manner, in the true spirit of the Rotary Code of ethics.

Eligibility

Any Citizen or group of citizens of Nepal or organizations registered as per Nepal law, engaged in the field specified by the award committee from time to time, having made following mentioned achievement, is/are eligible for the award:

  • Consistently displays excellence in the profession, business and industry,
  • High ethical and moral value,
  • Demonstrates vision, innovation or creativity and courage to take risk,
  • Provide inspiration and motivation to others,
  • Displays sustained and significant commitment to career specialty in profession or service field or beyond,
  • Enriches and improves the quality of life of others and promotes and supports the expansion of opportunity
  • for others in the community,
  • Over and above call of duty
  • Tangible impact in relation to resources employed (spread and intensity),
  • Educative value

However, the selection committee would make its independent assessment keeping in mind these criteria and any other relevant information available with them.

The GKRRA VE award committee can also select any individual, group of individuals or organization for which the nomination might, or might not have been received.

The award may be withheld by GKRRA VE award committee of Rotary International District 3292 in any year, if in the opinion of the committee, no meritorious nomination is received.

Procedure of Nomination

  • The nomination should be sent to the specified address in the prescribed form (available for download at RI District 3292 website www.rotarydistrict3292.org.np)
  • Eligible nominators may nominate no more than one eligible candidate.
  • A maximum of hundred words biography of the candidate should be enclosed along with the nomination form.
  • If the nominee is an individual or group of individuals;
    • Copy(s) of citizenship certificate(s)
    • Passport size photograph(s) be attached along with the nomination form
  • If the nominee is an organization, copy of renewed registration certificate be submitted
  • A document showing an evidence of the nominee involved in the said field may also be required.

Eligible Nominators

  • Any Rotary Club in good standing within Rotary International District 3292.
  • Organizations working in the field specified by the GKRRA VE award committee from time to time, registered and renewed as per Nepal law.
  • Any citizen of Nepal
  • A copy of citizen certificate in case of individual nominator, a renewed registration certificate in case of Nominating organization is mandatory.