Nominations for Dr. Shantha Radhakrishna Endowment Award

Dr. Shantha Radhakrishna Endowment Award Nomination Form

Please fill the form and mail it the address below. No softcopy please. This award shall carry a cash prize of Rs. 10,000 and a citation.

The award ceremony will be during the last week of January every year. This award is given every year for an individual working for the rehabilitation of hearing impaired in any category.

Last date for receiving the application : 20th November 2018.

Mailing address :
S. T. Radhakrishna, Trustee
SGS Vagdevi Centre for the Rehabilitation of communication Impaired
3rd C Main, 7th Cross, Girinagar II Phase,
Bengaluru – 560085. Karnataka

1. Name in English(in BLOCK Capital letters)
2. Address with telephone numbers
3. E-mail address
4. Date of Birth/Age
5. Sex
6. Category :
Early identification/intervention/education/pre-vocational and vocational training /placement
7. Institution with which the individual is associated including the local and field performances and the number of persons with disabilities covered.
8. How is the performance of the individual adjudged as outstanding
9. Remarks including a brief life sketch of the individual.
10. No. of years working with hearing impaired population
11. Details of her/his contribution during last ten years supported by documentary evidence.
12. Whether received any awards in the past, if so specify and furnish a brief account.
13. Name of the Area/District/State in which outstanding work has been done for the welfare of persons with disabilities.
14. Details of outstanding professional achievements, if any
Signature Date :
Place :