Proforma to Be Filled by Evaluator for Mid-Term Evaluation

PROFORMA TO BE FILLED BY EVALUATOR FOR MID-TERM EVALUATION. (STATE FOREST DEPARTMENT) (Format approved on 19.12.2006) Section –“A”

1. Name and Address of Voluntary Agency:

2. NAEB’s Ref. No. :

3. Fund Released (Year –wise) :

4. Species Procured :

Sl.No. Name of Species No. procured Percentage of total target 1. 2. 3. 4. 5. Total

5. Details of land covered for plantation (in case of private lands/land, identification details should be provided viz, Patta No. or Khasra No./khatauni No. as per State Government record)

(a) Name of Village : (b) Status of land : (c) Details of land with Khasra/Plot no : (d) Area in Ha. : (e) Map of the plantation site marked on the revenue/compartment (if forest land) map of the village:

2. Approximate distance from nearest forest including the status and name of that forest block:

3. (a) Certificate of SFD that only QPM has been used for planting:-

(b) Type of QPM (eg. Improved seeds, root trained seedlings, tissue culture raised seedling, etc). Section-“B”

1. Location of Nursery

2. Nursery Stock (Total no.of seedlings)

Target Achievement Remarks

(a) Fuel/Fodder :

(b) Fruit :

(c) Others :

(In case seedlings procured from other source, name of the sources)

3. Plantation Work: Target Achievement Remarks

(a) No. of Plants planted:

(b) Area covered (Ha) :

(c) Plantation model :

4. Details of Soil & Moisture Conservation Work carried out by VA:

Types of SMC work Approx. Quantity

5. Details of Measures carried out by VA for protection of plantations:

6. Other Items if any: Section-“C”

Qualitative assessment of the nursery work (The assessment should cover aspects pertaining to general health of plantation, overall survival percentage, general perception of local people about the project, any other remarkable features observed during the course of evaluation):

(A) Name and Designation of the Inspecting Officer (Not below the rank of Dy. Conservator Forest of the concerned Forest Division):

(B) Date of inspection

(C)General Health of Plants:

( D)Survival Percentage:

(E)General perception of local people about the Project:

(F)Degree of people’s participation and extent to which Agency could work as a catalyst or facilitator to mobilize people’s participation in tree planting/forest regeneration.

(G)Comments on the Justification and Quality of SMC works carried out:

(H).On the basis of the above, the overall performance of the agency (Name of the Agency:)……………………………... ………………………… may be graded as Outstanding/Good/Average/Poor.

(Signature of Evaluator)

(Name and Designation of the Evaluator) Place……………….

Date………………..

N.B: Name and Designation of the Evaluator (with official seal) and Date of evaluation should invariably be mentioned in the report.