BHARATHIDASAN UNIVERSITY, TIRUCHIRAPPALLI 620 024

NATIONAL SERVICE SCHEME

SPECIAL CAMP PROPOSAL FORM
Health, Public Sanitation and Personal Hygiene
Hygiene 20 - 20 .
1. Name of the College with full :
Postal Address & Contact no. :

2. Name of the Principal :

3. Contact No. of the Principal :

4. Details of the Programme Officers :

Name of the Programme
Date of Appointment
officer(s) who will be Residential Address Phone No.
as NSS PO
conducting the Camp

5. Name of the Teacher(s) deputed to help the

Programme Officer(s) :

6. Camp Venue (Village Name)* :

Name of the Panchayat Union :

Full address of the Camp :

Contact Phone No. at the Camp spot :

7. Distance of the Camp spot from College :

Mode of Conveyance :
Fare :
8. Proposed Camp Strength
i. No. of Camp Organiser(s)/Programme Officer(s) :
ii. No. of N.S.S. Volunteers :
iii. No. of Non Student / Local Youth :
Total :

9. Camp Dates : From _______________ to ________________

10. Projects to be completed during the Camp**

Name of the Project Project Spot Project Duration No. of No. of
Campers Beneficiaries

11. Name of the Govt. Dept. / Voluntary :

agencies co-operating

12. Date and Venue of the previous camp :

13. Amount granted by the University :

for the Camp

14. Whether the Camp was conducted :

or postponed or cancelled

15. Whether the amount was utilised :

or refunded or retained

16. Whether the audited Statement of :

Accounts and Report were sent

Programme Officer(s) College Seal Principal

* Kindly select a remote village which is away from the main roads.
** Kindly use additional sheets if required.