NATIONAL SERVICE SCHEME DIRECTORATE OF V.H.S.E. PROFORMA FOR SPECIAL CAMPING 1. Name of school and unit No.
: ………………………………………………
2. Name of Programme Officer
: ………………………………………………
3. Theme of special camp
: ………………………………………………
4. Schedule of camp
: ………………………………………………
5. Place of Camp with full details
: ………………………………………………
6. Details of volunteers selected
:
Boys
Girls
Total
(i) Student
..………
…………
…………
(ii) Non-students
..………
…………
…………
(iii) Teachers
..………
…………
…………
7. Place of work 8. Address of the nearest telegraph Office / contact phone no. with
: ……………………………………………… : ……………………………………………… : ………………………………………………
STD code. 9. Route from the school to the camp site ( in detail ) 10. Distance from the school
: ………………………………………………
……………………………………………… : ………………………………………………
11. Whether the camping programme is in the adopted slum / village
: ………………………………………………
12. Agencies / departments contacted and proposed to be involved
: ………………………………………………
13. Details of projects to be taken up : ……………………………………………… during the camp period (Separate sheet may be used)
: ………………………………………………
……………………………………………… ………………………………………………
14. Any other information
: ……………………………………………… Signature of Programme Officer
Counter signature of Principal Place : ……………………… Date : ………………………