ROORKEE SCHOOL FOR THE DEAF (A Social Initiative of IIT ) INDIAN , ROORKEE -247 667 (UK) Ph: + 91 -1332-285838, 286095 , Fax : +91-1332-273560 Mobile: +91- 931 951 9393 Contribution / Donation Form

On the high-tech campus of IIT Roorkee We, the members of the School Management Committee of Roorkee School for the Deaf would like to bring to your kind notice the noble work we are trying to do to educate the deaf children of Roorkee whereas less blessed deaf children are receiving “Quality Education” with the help of people like you. The school is managed by a group of highly educated IIT Roorkee faculty. However, the modelling of the school is such that it does not receive any grant from the government or IIT Roorkee and majority of its expenses are met out of donations received from individuals , organizations and well wishers of RSD.

Your little timely help will open the door of ample opportunities for education to many. The phrase “God helps those who help the needy / handicapped” is truly applicable here. Little money may not seem much to you but it does mean a lot to us. The money donated by you would be utilized for meeting the recurring expenses of the school which includes salary of the school staff, providing educational material to students, development of language Teaching Learning Material for teaching the deaf children, designing & fabrication of sophisticated teaching aids and other general expenses like stationery, equipment & building maintenances, etc. or as specified by the donors. Any other information, if required by you, may be furnished, on request.

Kindly send donation in the form of cheque / draft in the name of “Roorkee School for the Deaf” at the school address. Or Banks Details for Direct Transfers:

Name of School Address Bank A/c Name and Branch Name and Branch Branch Account Number. Address IFSC Code Code Roorkee School for IIT Roorkee, Distt. M/s Roorkee School for State Bank of , SBIN0001069 1069 the Deaf the Deaf IIT R Branch ,IIT , A/c No. 10660280480 Roorkee Pin – 247 667 You can make a Difference & Shape a Destiny today……………………………..

‰ I/we would like to make a donation of Rs. …………………………………………………………………. ‰ I/we would like to Volunteer /Fund Raising Ambassador my /our time and skills. ‰ Please send me /us Receipt Book –cum- School Brochure for collection of Funds .

1. Name of the Contributor’s / Donor: ______(If the contributor is a company / organization, please provide the contact person’s name and his designation)

a) Current Mailing Address : b) Permanent Mailing Address :

Name & Address Name & Address

Mob/ Tel Nos. Mob /Tel Nos. Fax :

Fax : e-mail : e-mail :

2. Type of Donation: ( Tick mark ) (i) MONTHLY DONATION / YEARLY DONATION / ONE TIME DONATION: Rs. ………………… (ii) CORPUS FUND DONATION: (a) This amount be kept as Fixed Deposit in the bank and ONLY its interest be used to meet the recurring expenses of Roorkee School for the Deaf for the purpose of educating the handicapped deaf children. Under no circumstances, this donation be used for any other purpose. (b) This corpus fund be kept under the name “….……………………………………………………………………….” (e.g. , the name could be kept as ” Sh. Kameshwar Prasad Memorial Fund” or “Sh. P. L. Nanda Trust Fund” or in the name of donor himself.) (iii) BUILDING FUND

3. If you may so wish please give the following details about the person(s) on whose special day you would be sending the donation : Name Relationship Special Occasion (Birthday / Date Amount to be sent Anniversary / Any other day ) i)

ii)

iii)

4. RSD spends @ Rs. 16000/- per child annually. It is proposed that you may also adopt children for their education by providing financial assistance. Please specify the no of children, you would like to adopt. No of children……………………………………..Amount of Donation Rs………………………………………………………………

5. I am enclosing my first donation of Rs……………………………..through bank draft/cheque No…………………………………… Dated……………………..The receipt for this donation be issued in favour of………………………………………………………….. 6. Will you like to send such donations to school in future also ? Yes/ No If, yes at what time or date or month in a year, so that school may remined you for such a donation.

Date: Signature: Please Note: 1. Please send Account payee draft/ cheque drawn in favour of “ROORKEE SCHOOL FOR THE DEAF”, payable at Roorkee. In case of donors from abroad you may send A/c payee draft /cheque in rupees of your account in India or else you may send donation in dollars to your relation in India who may encash the dollars and then send an equivalent amount through his Indian cheque / draft to the school. 2. Kindly send the filled up form and the draft/ cheque to Principal, Roorkee School for the Deaf, Indian Institute of Technology, ROORKEE -247 667 (Uttarakhand), India. Mob: 9319519393. 3. If you know anybody else who would like to support RSD, please fill the following details. 1. Name ______

Address ______

______

______

Ph Nos ______Fax______

email id ______

Mobile ______

2. Name ______

Address ______

______

______

Ph Nos ______Fax______

email id ______

Mobile ______