Partnership Request Form (CSR Collaboration)

Organization Name:

Contact Person Name:

Designation:

Email Address:

Phone Number

Office Address

Website / LinkedIn Profile:

Preferred Theme (s) of Collaboration (Tick all that apply)

S.No.	Themes	Check
1	Education & Skill Development
2	Health & Nutrition
3	Rural Development & Agriculture
4	Environment & Sustainability
5	Women Empowerment
6	Livelihood & Entrepreneurship
7	Watershed & Natural Resource Management
8	Other

S.No.	Type	Check
1	Financial Support (CSR Funding)
2	Technical Expertise / Knowledge Sharing
3	Employee Volunteering
4	Infrastructure / Resource Support
5	Multi-stakeholder Collaboration

Indicative CSR Investment Range (Select One)

Brief note on CSR Priorities / Focus Aresa:

Preferred Mode of Engagement (Online Meetings ,site visits, Workshops,etc):

Upload CSR Policy / Annual Report (optional):

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Central Office:- 180 Bhuiyadih, Infront of Jusco Pumping Station, Jamshedpur - 831009

District Project Office :- West Singhbhoom -Barjo Complex , Mahudi , Indira Tola , Aikuti , Noamundi Bazar , West Singhbhum - 833218

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