PROFORMA FOR SUBMISSION OF PROJECT PROPOSALS

Part I: General Information

Step 1 of 7

Name of the Medical College *

Please enter the name of the medical college.

Registration Number *

Please enter registration number.

Note: Enter your Registration Number, then select Load or Fetch Draft to restore previously saved details.

Address *

Please enter address.

Phone Number*

Please enter exactly 10 digits.

E-mail *

Please enter a valid email address.

Website

Competent Authority of the Institute forwarding the Proposal:

Name *

Please enter name.

Designation *

Please enter designation.

Mobile Number *

Please enter 10 digits.

E-mail *

Please enter valid email.

Project Coordinator / Nodal Officer Details

Name *

Please enter coordinator details.

Designation *

Please enter coordinator details.

Mobile Number *

Please enter 10 digits.

E-mail *

Please enter valid email.

Project Summary (max 200 words) * 0 / 200 words

Please enter project summary (maximum 200 words).

Part II: Institution Information

Step 2 of 7

Number and names of academic departments with number of associated faculty in the department *

#	Department Name	Associated Faculty	Action
1
Departments: 0,		Faculty Total: 0

Total Student Strength (Separately for UG / PG Courses)

UG Course Strength *

Please enter UG strength.

PG Course Strength *

Please enter PG strength.

Total Students

Total number of teaching and research faculty *

Please enter number of teaching and research faculty.

Number of patents granted during last five years *

Please enter patents granted during last five years.

Number of Publications published during last two years *

Please enter publications published during last two years.

Details of R&D being carried out in the institution for past 5 years and its outcomes to support and justify this application *

Please enter R&D details and outcomes.

Part III: Institute’s Preparedness

Step 3 of 7

Profile of Institute (which must capture background, duration since inception, focus areas, infrastructure & equipment, capacity, facilities, number of startups supported, awards and recognition etc.)*

Please enter Profile of Institute (which must capture background, duration since inception, focus areas, infrastructure & equipment, capacity, facilities, number of startups supported, awards and recognition etc.).

2. SWOT analysis of Institute with 200 words (50 words in each of the 4 aspects listed below) Total: 0 / 200 words

Strengths * 0 / 50 words

Please enter strengths (max 50 words).

Weaknesses * 0 / 50 words

Please enter weakness (max 50 words).

Opportunities * 0 / 50 words

Please enter opportunities (max 50 words).

Threats * 0 / 50 words

Please enter threats (max 50 words).

3. Justification of why the institution is keen to apply for the ANVESH program. (max 200 words). * 0 / 200 words

Please enter justification (maximum 200 words).

Part IV: Incubation and Startup Related Activities

Step 4 of 7

List of mentoring, networking, enablement activities conducted at the institute for last 2 years related to technology in HealthCare *

Please enter activities list.

2. What according to you are key elements of the success factors influencing the performance of the program in your institute (100 words) * 0 / 100 words

Please enter success factors (maximum 100 words).

3. Any other information/success story that you might want to furnish to support your application in up to 100 words. 0 / 100 words

Coordinator / Nodal Officer Experience & CV Attachment

4. Experience and Expertise of the Coordinator/Nodal officer from Institution identified for the ANVESH program *

Please enter coordinator experience.

Attach a brief CV/bio-data, a person with domain expertise and having conceptual understanding and deep interest for innovation and entrepreneurship would be preferred to steer the program *

Upload Coordinator CV

PDF only (Max 50MB)

Any other notable activities in innovation and entrepreneurship *

Please enter notable activities.

How much built-up area will be made available for the project? (Minimum 1,000 Sq. Ft.) *

Sq. Ft.

Area must be at least 1,000 Sq. Ft.

Attach Time-Linked Activity Chart *

Upload Activity Chart

PDF only (Max 50MB)

Year-wise work plan for five years (a separate time linked activity chart to be provided along with the detailed work plan)

Please enter five-year work plan.

Part V : Existing Facilities / Collaboration

Step 5 of 7

Existing Facilities Available *

Please describe existing facilities available.

Collaboration with Other Institutions / Organizations (If Any)

Industry Collaborations

Reputed National & International Universities / Institutions

Industry Associations & Charter of Engagement

Mentors Associated

Part VI: Budget Particulars

Step 6 of 7

The budget breakdown is optional. You may complete the table below or upload a budget PDF if your proposal uses additional or different budget heads(Maximum ₹20 Lakhs).

Sub-Total Non-Recurring (A)

₹ 0.00 Lakhs

Sub-Total Recurring (B)

₹ 0.00 Lakhs

Grand Total Outlay (A + B)

₹ 0.00 Lakhs

Sl. No.	Budget Head	Year 1 (₹ Lakh)	Year 2 (₹ Lakh)	Total (₹ Lakh)
A	NON-RECURRING
1	Renovation / furnishing of space
2	Office equipment, including communication network
	Total A — Non-recurring	-	-	-
B	RECURRING
1	Travel
2	Utility and maintenance
3	Marketing, promotion and publicity
4	Networking and training programme
5	Other administrative expenses, including consumables, printing, publications, books and journals
6	Miscellaneous and contingencies
7	Licences and subscriptions
	Total B — Recurring	-	-	-
	TOTAL (A + B)	-	-	-

Upload budget in PDF format (optional)

Upload Budget PDF

PDF only (Max 50MB; optional)

Part VII : Declaration/Certification (By Head of the Institute/Competent Authority)

Step 7 of 7

I/we hereby declare that the information provided in this proposal is true and accurate to the best of my/our knowledge. We also agree to abide by the rules and regulations governing the submission and evaluation of project proposals.

You must agree to the declaration statement.

Download and print the declaration on the institution’s letterhead.

Download and print the declaration on the institution’s letterhead. Fill in the required signatory details, obtain the authorized signatory’s signature and the institution’s seal, and upload the completed, signed and sealed PDF below.

Download Declaration PDF

Upload Completed Declaration PDF *

Upload signed and stamped PDF

PDF only (Max 50MB)

PROFORMA FOR SUBMISSION OF PROJECT PROPOSALS FOR CHARAKA

Before You Begin

CHARAKA ANVESH INSTRUCTIONS

Part I: General Information

Part II: Institution Information

Part III: Institute’s Preparedness

Part IV: Incubation and Startup Related Activities

Part V : Existing Facilities / Collaboration

Part VI: Budget Particulars

Part VII : Declaration/Certification (By Head of the Institute/Competent Authority)