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Asg 1 Scout / Guide Rajya Puraskar / Rashtrapati Award Registration Form

The document is a registration form for Scouts and Guides in the state of Bharat to apply for the Rajya Puraskar (State Award) or Rashtrapati Award (President's Award). It requests information about the applicant's scouting activities and qualifications, including requirements completed at different stages. Certificates and proofs of activities like proficiency badges, camps, hikes, and community service projects must be enclosed with the application.

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Karunamoorthy Periasamy
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508 views

Asg 1 Scout / Guide Rajya Puraskar / Rashtrapati Award Registration Form

The document is a registration form for Scouts and Guides in the state of Bharat to apply for the Rajya Puraskar (State Award) or Rashtrapati Award (President's Award). It requests information about the applicant's scouting activities and qualifications, including requirements completed at different stages. Certificates and proofs of activities like proficiency badges, camps, hikes, and community service projects must be enclosed with the application.

Uploaded by

Karunamoorthy Periasamy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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AFFIX RECENT

THE SOUTHERN RAILWAY STATE BHARAT SCOUTS AND GUIDES PASSPORT


State Head Quarters, Chennai 600 003
SIZE PHOTO
RAJYA PURASKAR / RASHTRAPATI AWARD REGISTRATION FORM

For the ASG 1


Reg No.
Year SCOUT / GUIDE

1. Name 2. Date of Birth

3. Father’s Name &


Designation & Office
Address
4. Mother’s Name &
Res. Address
5 Name of the Group & Address 6.Aadhar No.

7.District 8. Date of Passing 9. Date of Investiture 10. Date of Passing 11. Date of
Pravesh Pratham Sopan Passing Dwitya
Sopan

12.Date of Passing Tritiya Sopan 13. Rajyapuraskar Certificate No. & Date

Certificate No. Received Date:


(Issued by Dist. Association)

Details of Activities done / Participated at various stages of Advancement.

B. DWITYA SOPAN
B.1.
Name of the Examiner &
Proficiency Badge Earned
Date of Passing Rank / Designation (for Non-
(Requirement for 10/12(Scouts / Guides) Scouter)

B.2. Sustained Activity using (Scouting / Guiding Skill (Req.No. 11 / 9 Scouts / Guides) ( 1 month)

Nature of service From Period To

B.3. Subjects chosen under requirement No.12 / 13 (Scouts / Guides) (2 subjects)


1.
2.
-- 2 --

C. TRITIYA SOPAN
C.1. Date of passing Swimming Test: (Enclose copy of the certificate)
Or Proficiency Badge earned requirement No. 2 / 2 (Scouts / Guides)
Name of the Examiner & Rank
Proficiency Badge Earned
Date of Passing / Designation (for Non-
(Requirement for 2 (Scouts / Guides)
Scouter)

C.2. Participation Overnight Camp Req. No. 7 / 7 (Scouts / Guides)


Period
Place
From To

C.3. Details of Hike Cycle 30 / 10 Kms. Foot 10 / 6 Kms for Scouts/Guides Req. No. 8 / 8 Scouts / Guides
(Enclose certificate from the Examiner) ( report within 10 days)
Dates Place Distance In Date of Report
KM Submission
From To From To

C.4. (Requirement No. 13/13)- Proficiency Badges


Sl. No. Proficiency Badge Earned Date of Passing Name of the Examiner & Rank /
Designation (for Non-Scouter)
1. Group A

2. Group B

D. RAJYAPURASKAR
D.1. Requirement No. 2 / 1) for Scouts / Guides (Enclose copy of the Certificates)
Sl. No. Proficiency Badge Earned Date of Passing Name of the Examiner & Rank /
Designation (for Non-Scouter)
1.

2.

3.Scouts
(only)

D.2. Requirement No. 3 / 2 for Scouts / Guides (Enclose copy of the Certificates)
Group. Proficiency Badge Earned Date of Passing Name of the Examiner & Rank /
Designation (for Non-Scouter)
A

B
--3 --

E. RASHTRAPATI AWARD
E.1. Details of Camp attended (3 Nights stay) Requirement No.2 / 2 (Scouts & Guides)
Period
Place From To Nature of the Camp

E.2. Proficiency Badge Requirement No.3 / 3 (Enclose copy of the Certificate) (Scouts & Guides)
Name of the Examiner & Rank /
Date of Passing
Ambulance Man / Ambulance badge Designation (for Non-Scouter)

E.3. Requirement No. 4 / 4 (Enclose copy of the Certificates) Scouts / Guides


Group. Proficiency Badge Earned Date of Passing Name of the Examiner & Rank /
Designation (for Non-Scouter)
A

E.4. Sustained service for 36 Hrs Requirement No.5 / 5 (Scouts / Guides) (Enclose certificate from the authority)
(Service related to Prime Minister Shield Competition)(2 months)
Period Total No. of Hours
Nature of service
From To

E.5. Details of Over Night Hike / Cycle Hike Cycle 50 / 10 Kms. Foot 15 / 8 Kms for Scouts / Guides Req. No. 6 / 6
(Enclose certificate from the Examiner)(report within 10 days)
Dates Place Date of
Distance In KM Report
Submission
From To From To

E.6. Sustained Community development project Requirement 7 / 7 (Enclose proof)


(Service related to Prime Minister Shield Competition)(6 months)
Project under taken (Health / Conservation / Literacy / Small Date of Date of Completion
Savings) Commencement

E.7. Details of Working as Badge Instructor(for Scouts): Requirement 8 / 8 (Enclose proof)


Name of the Proficiency Name of the No. of Persons Produce Certificates from Badge
Badge(s) Group (s) benefited Secretary

OR Teaching Games (15 days)/ Show Interior Decoration / Fancy Cooking (Guides only) (Enclose proof)
Date Produce Certificate Total No. of
Place
from authorized Children involved
From To person
--4 --
The following Certificates / Proof are enclosed herewith:

Sl. Details of the Certificate Check List


No.
1. Bonafide Birth Certificate Issued by the Educational Institution or attested SSLC mark list
2. Dwitya Sopan Qualifying Certificate from the District Assn.
3. Tritiya Sopan Certificate from the District Assn.
4. Dwitya Sopan Proficiency Badge Certificate 1 certificate
5. Dwitya Sopan Sustained activity Certificate
6. Tritiya Sopan Swimming / Proficiency Badge Certificate
7. Tritiya Sopan Hike completion from the Hike Examiner
8. Tritiya Sopan Proficiency Badge Certificate 2 Certificates
9. Rajyapuraskar Proficiency Badge Certificate 5 / 4 Certificates
10. Xerox copy of Rajyapuraskar certificate (If Awarded)
11. Rashtrapati Std., 3 Days Camp Certificate from the Examiner
12. Ambulance man / Ambulance Prof., badge Certificate
13. Rashtrapati std., Proficiency Badge Certificate 2 certificates
14. 36 Hrs Service Certificate ( Duration minimum 2 months )
15. Rashtrapati level Hike completion from the Hike Examiner
16. Sustained Comm. Development Project completion Certificate
17. Proof of Badge Instructor / Teaching Games

Signature of the Scout / Guide


Date:

Certified that the Mr/Ms _ Scout / Guide is Registered member and


Renewed from the period Pravesh to till date as shown in this application form and forwarded to State
Headquarters with all the enclosures for acceptance .

Signature of the SM / GC Signature of the Group Leader


Name: Name:
Scouting / Guiding Qualification:

DOC(S/G) District Commissioner (S/G)


Date: Date:
Name: Name:

Received at the State Headquarters on

SOC (S/G)
Details of the Testing Camps Attended

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