Alumni Initiative Summary Form

PRERANA

PRERANA: AN EXPERIENTIAL LEARNING PROGRAM

ALUMNI INITIATIVE SUMMARY

Personal Details (Fill without use of abbreviations)

1. Name of the Student:

Paste Passport Size Colour Photograph (with white background) *

2. Class (at the time of Prerana Program): 2(a). Complete School and Home Address with District and State:(at the time of Prerana Program) 3. Batch Number and Dates Attended (from ___ to ___):

4. Class (update, if changed): 4(a). Complete School/College Address with District and State (update, if changed): 5. Contact Number *: 6. Email ID *: 7. Social Media ID (if any):

Gist of the Initiative or Activity Taken

(Give clear responses and leave the columns, which are not applicable)

8.Briefly describe the initiative/activity taken demonstrating value/(s) of Prerana Program (maximum 500 words): Process (steps taken to plan/implement) : Purpose (aim/need/ problem to address) Location (Where and when) Motivation (inspiration to start) 9. Impact of the initiative/activity (with Beneficiaries/Target Group) and role in the vision of Viksit Bharat: 10. Whether it is/was an individual initiative/activity or teamwork (complete details): 11. Resources utilised/mobilized (physical/human/IT/financial etc., if any): 12. Collaborating agency (if any): 13. Facilitation/Certificate/Recognition for the initiative taken (if any, at any level): 14. Pictures/Photographs/Videos or supporting materials of the initiative/activity (Share at-least 3-4 or provide accessible drive link): 15. Any poem, article, reflection, or creative piece written by you(inspired by your experience of ‘Prerana Program’): 16. Anything else you would like to share (any suggestions or feedback): Security Question *