Scheme Of National Award To Teachers - New Delhi Department Of School Education And Literacy Page 14

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Please Note:- Two passport size photograph
Space for
affixing
DULY attested on back side by any Gazetted
Passport
Officer of your Town, Tehsil or District be attached
size
in separate envelope. The Photograph should not
Photographs
be defaced in anyway.
PROFORMA FOR RECOMMENDING A TEACHER FOR
NATIONAL AWARD
Parts A, B and C are to be filled by the Principal/Head of the School in case of a teacher and by
the Chairman, Managing Committee of the School in case of Principal from sources such as
Teacher’s Diary, records of inspection, records kept by the Principal, Examination results of
the school, Confidential reports and service book etc. of the teacher.
PART-A
Particulars of the teacher/Principal
1. Name (in Block letters)
:
___________________________________________
2. Designation & complete school address _____________________________________
with Pin code number, Telephone number:
3. State:
_____________________________________
4. Date of birth:
_____________________________________
5. Present age:
_____________________________________
6. Date of superannuation:
_____________________________________
7. If superannuated, please clarify
_____________________________________
whether extension has been given
by the Competent Authorities with
supporting documents
8. Sex:
_____________________________________
9. Marital Status:
_____________________________________
10. Residential address with Pin code
_____________________________________
number, Telephone Number:
- 13 -

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