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Shaktidoot Application Form

Note : ( * ) Indicates fields are required.

Application for inclusion in Shaktidoot Scheme 2019-20

To,
Secretary,
Sports Authority of Gujarat
Gandhinagar

(Upload Photo)

1. Name of Player*
Surname
Name
Father's Name
2. Communication Address*
Pin Code*
Phone/Mobile No.*
E-mail Id*
3. Name of Sports*
4. Gender*
Male Female
5. Cast*
SC ST OBC GENERAL
6. Date of Birth*
   
Years    
(As on 31st March 2019)
7. Name of Coach*
Address of Coach*
Phone/Mobile no. of Coach*
Email id of coach
8. Domicile Certificate (Yes / No)*
Certificate
9. Annual Family Income*
10. Name of National Association*
Address of National Association*
Phone /Mobile of National Association*
Email of National Association*
11.
Details of National/International level competition organized by School/Association (Junior /Sub Junior category)
(Last two years performance) eg. April 2017- March 2019 MedalAttachment Box
Event Name of competition Place Date of competition Year Gold
Silver
Bronze

   
Details of National/International level competition organized by School/Association (Senior/Open Age Group)
(Last two years performance) April 2017 – March 2019MedalAttachment Box
Event Name of competition Place Date of competition Year Gold
Silver
Bronze

12. Is any financial help/Scholarship availed from some other organization? If yes give details
Name of Organization Amount Purpose
13. Give details of purpose for which financial support is needed under Shaktidoot Scheme
Purpose of financial support Amount
Uniform
Nutrition
Equipment
Training/Expert coach fees
Residential Expense
Travel Expense
Stipend
Miscellaneous expense
(medicine, insurance etc.)
14
Bank Details
Name as on Bank Record
Bank Name
Bank Account Number
Bank IFSC Code
Branch
15
Aadhar Card Number

I hereby assure that above mentioned information are true as per best of my knowledge.

Player Name

Player Signature

This is to certify that Shri/Kum
Has participated in
National/International level event and achieved
Position, This competition was held at
during
to
This details are verified and approved herewith
Sign,

Hon. Secretary,
State Level sports Association

Note

  • Application Forms with Incomplete details or without attested certificates can be rejected.
  • One passport size photo should submit separately with physical application form. (mention the name applicant name and game on backside of photo)
  • An Applicant have to submit certificates of achievements in sports in online application form (if required attach it separately with physical form also)
  • States level performance will be not considered for Shaktidoot Scheme.
  • Certificates of Achievements should be verified & attested by respective State Sports Association with signature and seal of authority.
  • Details shown in column no 13 an Applicant can submit details of expected yearly expenditure related to Sports Kit, Equipment, Coaching fees, travelling expenses applied for.
  • An Applicant have to fill online form with all necessary information, submit the form online and send physical copy with all uploaded documents to Chief Coach, Sports Authority of Gujarat, Block 14,3rd Floor, Dr. Jivraj Mehta Bhavan, Gandhinagar – Pin 382011 on or before 20 July 2019, 6:00 PM
  • Late submitted Application will be not considered.