NATIONAL SERVICE SCHEME HIGHER SECONDARY EDUCATION SELECTION LIST OF NSS VOLUNTEERS FOR PRE-REPUBLIC DAY PARADE CAMP 2013 FROM 7 TH TO 16 TH OCTOBER 2013 MAHENDRA ENGINEERING COLLEGE, MALLASAMUDRAM, NAMAKKAL DISTRICT

SL. NAME M/F NAME OF SCHOOL DISTRICT PHONE NO. NO . 1 MINU ROSE FRANCIS F ST.DOMINICS, KANJIRAPALLY KOTTAYAM 9446404022 2 LAYA BALAKRISHNAN F GHSS, AYAPARAMBU ALAPPUZHA 9656792564 3 KAJAL JAMAL F ST.GEORGE HSS, VAZHATHOPE IDUKKI 9497280388 4 ANASWARA S MALIKAYIL F GHSS NORTH, PARAVOOR ERNAKULAM 9895186077 5 ANJANA G.N. F GGHSS COTTONHILL TVPM 9495470313 6 ANJANEYAN J SAGAR M GHSS VELLATHUVAL IDU KKI 9895336960 7 ABHIJITH.K.S M SNHSS, AYYAPPANKAVU ERNAKULAM 9633869497 8 NARAYANAN M GHSS CHAVAKKAD 9745503148 9 ANANDAKRISHNAN.E M ST.GEORGE HSS, THALASSERY KANNUR 9846193581 10 AJMEL RAFEEQ.K M HIMAYATHUL ISLAM HSS KOZHIKODE 9142046900 CONTEGENT LEADER : Smt. MAYADEVI.K.A, PROGRAMME OFFICER, GOVT.HSS CHAVAKKAD, THRISSUR, PHONE NO. 9633118627, EMAIL.ID- mayadevika @ gmail.com How to reach venue: 27 Kms from Salem Railway Station and on the Salem- Thiruchengode Highway. Reporting time : 6th evening or 7 th morning of October 2013 Contact Officers at Salem: 1.Mr.G.P.Sajith Babu, Youth Officer – 09962881972 2.Mr.Rajkumar, Youth Officer – 09381022759 Documents to be submitted in ORIGINAL: • Indemnity Bond (Format Attached) • Physical Fitness Certificate/Medical Certificate (Format Attached) • NSS Volunteership Certificate (Format Attached) • Nomination Form (Format Attached) • Passport size colour photographs – 2 Nos. LIST OF ITEMS TO BE CARRIED BY THE PARTICIPANTS 1. Pen & Note book for daily diary writing 2. White & 2 Pair of White (for physical exercises/Training) 3. Black Shoes & Black Socks (for Parade practice) 4. 2 White & 2 White Pants for Boys & girls (for Parade Practice) 5. A pair of /Chappel for daily use. 6. NSS Badge 7. School ID Card 8. Torch Light with Cells 9. case with lock 10. Light beddings 11. Toiletries (bath & washing soap, Oil, Creams etc... for Daily routine use.) 12. Musical instruments/costumes and make-up materials for cultural programme. 13. Traditional Costumes for Girls & Boys which is to be worn at important days ( The typical Kerala dressing for Girls in ‘Set ’(White saris with borders of gold thread (Kasavu) and matching the border colour. Boys white dhoti with ‘Kasavu’ borders with matching colour .) 14. Audio CD/DVD/Pen Drive songs for cultural performances (not cassettes)

The participants should not carry any costly items including jewelry

Annexure-I

REPUBLIC DAY PARADE CAMP -2013 -14 NOMINATION FORM FOR STATE/UT LEVEL SELECTION CAMP

A: PERSONAL DETAILS (in capital letters)

Name: Mr./Miss ______(Surname ) (First name) Nomination is for………….. Date of birth: ______Father’s Name: ______Mother’s Name: ______Educational Qualification: ______

B: CONTACT DETAILS

(i) Contact Address & Telephone no. (ii) Permanent Address & Telephone no Telephone No(s): Telephone No(s): Mobile No(s): Mobile No(s): E mail ID

C: NSS UNIT DETAILS

(i) Name & Address of Prog. Officer (i) Name & Address of Prog. Coordinaor Telephone No(s): Telephone No(s): Mobile No(s): Mobile No(s):

D: OTHER DETAILS

(i) Height (in cm) ______(ii) Weight (Kg.) ______(iii) Food habit: Veg/ Non-Veg____ (iv) Blood Group: ______(v) NSS Camps attended: (vi) NSS Enrollment Year: ______(viii) Hobbies:

Signature of the Prog. Officer & Date Signature of the Volunteer & Date (SEAL)

Annex.-II

Certificate of Medical/Physical Fitness – A Specimen

Signature of the Candidate……………………………………...

I do hereby certify that I have examined Mr./Ms……………………………Son/Daughter of…..…………………………… and found fit for undergoing rigorous training for Pre-Republic Day/Republic Day Camp.

The candidate whose signatures are given above is not suffering any communicable or chronic disease, which may cause any hindrance in his/her participation in the above-mentioned rigorous training programme.

Signature of the Medical Officer with Seal

Station:______

Dated:______

Annexure -III FORM OF INDEMNITY

In consideration of my being nominated at my request to undergo all types of training and also participating in any camp/course/ adventure training activities in/ outside NSS and traveling I undertake and agree that neither I nor my executer/ administrator will make any claim against the Government of India or against any officer of NSS/ Principal/ Programme Officer/Programme Coordinator/ State Liaison Officer/ / Youth Officer/ Assistant Programme Adviser/ Deputy Programme Adviser/ Programme Adviser in respect of any loss or injury to the property or person (including injury resulting in death), which may suffer while or inconsequence of my being in training/ participating in any camp / course/adventure training activities in/out side NSS and traveling and I understand that no compensation will be paid by Government of India or any Officer as mentioned against any such loss or injury (including injury resulting in death) and I agree so as to bind myself, executers and administrators to indemnity to the Government of India, any NSS official and any person in the service of Government of India, against any claim which may be made any third party against them or any of them arising out of any act or default on my part during or in connection of said training camp course/ NSS Pre-RD parade/ RD parade camp /adventure training / Mega Camp and journey by road/ rail/ seal river/ and flight

Signature of applicant

Signed by the applicant with address

In the presence of Sh. ------

Witness 1 ------

Witness 2 ------

NB: one of the witness must be the parent I guardian of the NSS volunteer with address

Annex.-IV

VOLUNTEERSHIP CERTIFICATE

It is certified that Shri/ Kumari ------Son / Daughter of Shri ------is a bonafide student of (name of institution) ------He/ she is a regular NSS Volunteer & from------and has completed his/ her one year of volunteership and he / she is neither a member of NCC nor a member of Scouts and Guides/ Rovers/ Rangers.

He has attended NSS Special Camp from……………....to…………….(date) at…………………………………………(venue).

Signature of Programme Officer Signature of Principal

With seal With Seal