Joy Bangla Youth Award 2017
Application Form
(only for organizations)
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2017
1 copy passport size
photograph of the
applicant
Av‡e`b dig
(ïaygvÎ msMV‡bi Rb¨)
Joy Bangla Youth Award 2017
Young Bangla, the biggest youth platform in Bangladesh, is organizing the second Joy Bangla Youth Award with the aim of bringing youth-led initiatives in
the remotest of areas to the limelight, in an attempt to make these proactive young individuals visible to not only their peers and social settings, but also to
local and national level government agencies and policymakers. Organizations/groups/clubs, who believe they deserve the award, can apply by filling up this
form. However, winners of Joy Bangla Youth Award 2015 will not be able to apply this year.
Terms and Conditions
1.
2.
3.
4.
In case any information provided is subsequently found to be untrue/false, the Centre for Research and Information (CRI) and Young Bangla
reserves the right to publicly cancel any award/benefit given to the applicant.
The applicant should be bound to supply/produce/present any documentation that CRI-Young Bangla might ask for. CRI-Young Bangla will not
ask for any other documentation other than those needed for scrutiny of the application. CRI-Young Bangla also promises to not use any of the
information/documentation for any purposes other than verification (with government and security agencies) of the applicant’s credentials.
The applicant must provide proof (photo ID card such as national identity card or passport) of identity, otherwise the application will not be accepted.
Applying for the Joy Bangla Youth Award 2017 also means that the applicant is giving consent to be a member of the Young Bangla platform and
be contacted by CRI-Young Bangla via email and other mediums for disseminating relevant information, including promotional offers/events.
 I agree to the terms and conditions.
Name of Organization*
msMV‡bi bvg
Area of Work*
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Kv‡Ri †ÿÎ
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Location*
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 Preventing Violence Against Women
bvixi cÖwZ mwnsmZv cÖwZ‡iva
 Preventing Drug Abuse
gv`Kvmw³ wbivgq
 Fighting Disasters
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 Youth Training & Development
hye cÖwkÿY I Dbœqb
 Social Services
mgvR‡mev
 Protecting the Environment
cwi‡ek myiÿv
 Sports Development
µxov Dbœqb
 Physical Education
kvixwiK wkÿv
 Welfare of Persons with Disabilities
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 Women Development
bvix Dbœqb
District
‡Rjv
 Preventing other types of violence
Ab¨vb¨ ai‡bi mwnsmZv cÖwZ‡iva
 Welfare of Vulnerable Communities
`y¯’ I Amnvq Rb‡Mvôxi Kj¨vY
 Liberation War
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 Adult Education
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 Child Education
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 Cultural Development
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 Tourism & Heritage
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 Library Development
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 Blood Donation
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Has your organization applied for Joy Bangla Youth Award before? *
‡Zvgvi msMVb wK Av‡M Rq evsjv Bqy_ A¨vIqv‡W©i Rb¨  Yes/n¨vu
Av‡e`b K‡i‡Q?
Has your organization won any award before? Write down the names below.
‡Zvgvi msMVb wK Gi Av‡M †Kvb cyi®‹vi wR‡Z‡Q? cyi®‹v‡ii bvg wb‡P wj‡Lv|
Division
wefvM
 No/bv
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Address of organization*
msMV‡bi wVKvbv
Phone/Mobile number of organization*
msMV‡bi ‡dvb/‡gvevBj b¤^i
Email of Organization*
msMV‡bi B‡gBj
Social Media Page
mvgvwRK †hvMv‡hvM gva¨g
Registration Number (if any)
‡iwR‡÷ªkb b¤^i (hw` _v‡K)
Registered as
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Year of Establishment*
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Number of Members*
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Are you the leader of your organization? *
Zzwg wK †Zvgvi msMV‡bi cÖavb
e¨w³?
Name of the Applicant*
Av‡e`bKvixi bvg
Applicant’s Mobile Number*
Av‡e`bKvixi ‡gvevBj b¤^i
Applicant’s Address*
Av‡e`bKvixi wVKvbv
 Yes/n¨vu
Applicant’s Email*
Av‡e`bKvixi B‡gBj
Father’s Name
evevi bvg
Mother’s Name
gv‡qi bvg
Date of Birth*
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 Male/cyiæl
Gender
wj½
Blood Group
i‡³i MÖæc
 Married/ weevwnZ
Marital Status
‰eevwnK Ae¯’v
National ID number*
RvZxq cwiPqcÎ b¤^i
Passport Number
cvm‡cvU© b¤^i
(RvZxq cwiPqcÎ bv _vK‡j cvm‡cvU©)
What is the aim/goal of your organization?*
‡Zvgvi msMV‡bi jÿ¨/D‡Ïk¨ wK?
(m‡e©v”P 50 k‡ã evsjv A_ev Bs‡iwR †h †Kvb GKwU fvlvq wj‡Lv)
 No/bv
 Female/bvix
 Others/Ab¨vb¨
 Unmarried/ AweevwnZ
 Others/Ab¨vb¨
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How is your organization working to achieve that aim/goal?*
‡mB jÿ¨/D‡Ïk¨ AR©‡b †Zvgvi msMVb wKfv‡e KvR Ki‡Q?
(m‡e©v”P 100 k‡ã evsjv A_ev Bs‡iwR †h †Kvb GKwU fvlvq wj‡Lv)
How is your organization’s work making a difference in the society/area?*
†Zvgvi msMV‡bi KvR mgv‡R ev GjvKvq wK cwieZ©b Avb‡Q?
(m‡e©v”P 100 k‡ã evsjv A_ev Bs‡iwR †h †Kvb GKwU fvlvq wj‡Lv)
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What does Joy Bangla mean for you?*
‡Zvgvi Rq evsjv wK?
(m‡e©v”P 30 k‡ã evsjv A_ev Bs‡iwR †h †Kvb GKwU fvlvq wj‡Lv)
Why do you think you deserve to win the Joy Bangla Youth Award?*
‡Kb Zzwg g‡b K‡iv †Zvgvi msMVb‡K Rq evsjv Bqy_ A¨vIqvW© †`qv DwPr?
(m‡e©v”P 100 k‡ã evsjv A_ev Bs‡iwR †h †Kvb GKwU fvlvq wj‡Lv)
I do hereby acknowledge that all the information provided in this form are true to the best of my knowledge.
Signature of the Applicant*
Av‡e`bKvixi ¯^vÿi
Date
ZvwiL
* ZviKv wPwýZ Ni¸‡jvi GKwUI hw` Lvwj _v‡K Zvn‡j Av‡e`b MÖnY Kiv n‡e bv|
* Star marked fields are mandatory. If any of them are left empty then the application will not be accepted.
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msµvšÍ †h †Kvb cÖ‡qvR‡b ev mvnv‡h¨i Rb¨ Kj K‡iv Avgv‡`i nUjvBb b¤^‡i: 09612009922|
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