Government of India Ministry of Rural Development Department of Rural Development

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1 Government of India Ministry of Rural Development Department of Rural Development Room No. 607, Block-11, CGO Complex, Lodhi Road, New Delhi Dated: Subject: Nomination of Non-Official Members to the State/District Level DISHA Committees The DISHA Committees constituted by the Ministry of Rural Development at State and District levels are expected to function as an important instrument for effective monitoring of implementation of Central Government Programmes. DISHA Guidelines provided for nomination of 4 (Four ) non- official members by the Ministry of Rural Development in both the State and District Level DISHA committees. The Guidelines of DISHA committees containing Terms of Reference, Composition, eligibility for non official members, etc., are available on the website of the Ministry ( Expression of Interest are invited from eminent person of the State/District from social academic or public fields having special knowledge or experience of social economic development in the State/district/region for nomination as non-official members. The membership of these committee are voluntary in nature and nominated members are paid TA/DA and daily allowance as mentioned in Guidelines for attending the meeting. Interested person may indicate his/her availability in the prescribed format (For nomination in State Level Committee may apply in FORMAT A and for nomination in District Level Committee may apply in FORMAT B by or by post so as to reach this Ministry on or before 30 th July, 2018, at the following address: Shri S.S. Prasad Under Secretary (Monitoring) Ministry of Rural Development Room No. 607, Block No.11 C.G.O. Complex, New Delhi ss[dot]prasad[dot]dord[at]nic[dot]in Sd/- (S.S. Prasad) Under Secretary to the Government of India

2 FORMAT A Application for nomination of Non-Officials to State Level DISHA Committees In pursuant with para 10.1 of the State Level Committee guidelines the willingness on behalf of the eminent individual is solicited for nomination of non- official members to State Level DISHA Committee. Format on which information is to be furnished provided is provided below: 1. Full Name of the Eminent person: 2. Gender : 3. Date of Birth: 4. Category (SC/ST/OBC/Others): 5. Address for communication: Affix passport size photograph (Self attested) 6. Name of the State/UT where the applicant resides: 7. Name of the State/UT committee for which nomination sought: 8. Academic Qualification: 9. Areas of specialization: 10. Field of Experience : (A one page note on experience in the field of social/academics/ public fields/ civil society organization need to be submitted along with the application) 11. Whether has been a Member of erstwhile State /District Level Vigilance & Monitoring committee/disha committee/ any other committee of the Central Government earlier? If so, give details. It is certified that the information given above is TRUE to the best of my knowledge. I will be liable for any information given above which is later found to be FALSE. Date: Signature

3 Application for nomination of Non-Officials to District Level DISHA Committees FORMAT B 1. Full Name of Eminent person: 2. Gender : 3. Date of Birth: 4. Category (SC/ST/OBC/Others): 5. Address for communication: Affix passport size photograph (Self attested) 6. Name of the District where the applicant resides: 7. Name of the District committee for which nomination sought: 8. Academic Qualification: 9. Areas of specialization: 10. Field of Experience : (A one page note on experience in the field of social/academics/ public fields/ civil society organization need to be submitted along with the application) 11. Whether has been a Member of erstwhile State /District Level Vigilance & Monitoring committee/disha committee/ any other committee of the Central Government earlier? If so, give details. It is certified that the information given above is TRUE to the best of my knowledge. I will be liable for any information given above which is later found to be FALSE. Date: Signature

4 भ रत सरक र ग र म ण व क स म त र लय ग र म ण व क स व भ ग कमर स ख य 607, ब ल क -11, स ज ओ पररसर, ल ध र ड, नई व ल ल व न क: व षय: व ल स तर य व श सव व य ग र-आव क ररक स स क न कन क द र सरक र क क यक रम क क य यन वयन क प रभ वनगर न क वलए ग र म ण व क स म त र लय द व र र ज य और वजल स तर पर व श सवमवतय क गठनवकय गय ह व श सवमवत क म गय वशयक म र ज य और वजल स तर य व श सवमवतय न म ग र म ण व क स म त र लय द व र 4 (च र) ग र-आवधक ररक स स क न म कन क प र ध न ह व श सवमवत क म गय वशयक वजसम सवमवत क स रचन, व च र र य व षय, ग र-आवधक ररक स स ह त प त रत इत य व म त र लय क बस इट ( पर उपलब ध ह ग र-आवधक ररक स स क र प म न म कन क वलए र ज य / वजल क स म वजक, श व क औरस यजवनक त र स सम ब वधत प रवतव त व यक त य स ज वक र ज य/ वजल क स म वजक आवर यक व क स क त र म व श ष ज ञ न य अन भ रखत ह स आ न आम वत रत वकए ज त ह इन सवमवतय क स स त स व क त क प रक वत क ह और न वमत स स क ब ठक म भ ग ल न क वलए व श वन श म उक तल लक तखत ट ए / ड ए और वनक भत त क भ गत न वकय ज त ह इ क व यक त अपन उपलब धत (र ज य स तर य सवमवत क वलए प र र प क वजल स तर य सवमवत क वलए प र र प ख)ईम ल य प स ट द व र वनध यररत प र र प म 30 ज ल ई, 2018 क य उसस पहल वनम नवलक तखत पत पर भ ज सकत ह : श र एस एस प रस अ र सवच (वनगर न ) ग र म ण व क स म त र लय क स ख य 607, ब ल क स ख य 11 C.G.O. क म प ल क स, नई व ल ल ई-म ल:ss[dot]prasad[dot]dord[at]nic[dot]in हस त / - (एसएस प रस ) भ रत सरक र क अ र सवच

5 प र र प क र ज य स र य व श सव व य क ग र-सरक र स स य क न कन क वलए र व क अव व यक त र ज य स तर य सवमवत व श -वन श क प र 10.1 क अन सरण, र ज य स तर य व श सवमवत क ग र-सरक र स स य क न म कनक वलए प रवतव त व यक त क सहमवत म ग ई ज त ह म ख य आवर यक सल हक र क अध य त ल अन ण सवमवत म व च र वकए ज न क वलए न च व ए गए प र र प म स चन म ग ई ज त ह र ज य स तर य व श सवमवत म ग र-सरक र स स य क न म कन म अन ण सवमवत क वनणयय अ वतम ह ग स न रन क वलए प र र प 1. प रवतव त व यक त क प र न म : 2. वल ग : 3. जन म वतवर :. स -हस त ररत प सप टय स इज फ ट लग ए 4. श र ण (अन.ज./अन.ज.ज./अ.वप../अन य): 5. पत र च र क पत : 6. र ज य/स घ र ज य त र क न म जह पर आ क रहत ह : 7. र ज य/स घ र ज य त र सवमवत क न म वजसक वलए न म कन म ग गय ह : 8. श वणक य ग यत : 9. व श षज ञत क त र : 10. अन भ क त र : (स व क/श क षव क/स व वनक क ष त र/वसव ल स स यट स गठन क क ष त र अन स स ब व एक प ष ठ क वटप प आ न क स थ प रस क न आ श यक ह ) 11. क य पहल, प य त र ज य/वजल स तर य सतकय त ए वनगर न सवमवत/व श सवमवत/य र ज य/क द र सरक र क अन य वकस त र य य र ष टर य सवमवत क स स य रह ह प रम वणत वकय ज त ह वक न च गई ज नक र म र ज नक र क अन स र सह ह म ऊपर गई ज नक र क ब म गलत प ए ज न पर उत तर य ह ऊ ग व न क हस त र

6 प र र प ख व ल स र य व श सव व य क ग र-सरक र स स य क न कन क वलए र व क अव व यक त वजल स तर य सवमवत व श -वन श क प र 3(ix) क अन सरण म, वजल स तर य व श सवमवत क ग र-सरक र स स य क न म कन क वलए प रवतव त व यक त क सहमवत म ग ई ज त ह म ख य आवर यक सल हक र क अध य त ल अन ण सवमवत म व च र वकए ज न क वलए न च व ए गए प र र प म स चन म ग ई ज त ह वजल स तर य व श सवमवत म ग र-सरक र स स य क न म कन म अन ण सवमवत क वनणयय अ वतम ह ग स न रन क वलए प र र प 1. प रवतव त व यक त क प र न म : 2. वल ग : 3. जन म वतवर : स -हस त ररत प सप टय स इज फ ट लग ए 4. श र ण (अन.ज./अन.ज.ज./अ.वप../अन य): 5. पत र च र क पत : 6. वजल क न म जह पर आ क रहत ह : 7. वजल सवमवत क न म वजसक वलए न म कन म ग गय ह : 8. श वणक य ग यत : 9. व श षज ञत क त र : 10. अन भ क त र : (स व क/श क षव क/स व वनक क ष त र/वसव ल स स यट स गठन क क ष त र अन स स ब व एक प ष ठ क वटप प आ न क स थ प रस क न आ श यक ह ) 11. क य पहल, प य त र ज य/वजल स तर य सतकय त ए वनगर न सवमवत/व श सवमवत/य र ज य/क द र सरक र क अन य वकस त र य य र ष टर य सवमवत क स स य रह ह प रम वणत वकय ज त ह वक न च गई ज नक र म र ज नक र क अन स र सह ह म ऊपर गई ज नक र क ब म गलत प ए ज न पर उत तर य ह ऊ ग व न क हस त र

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