Bala Kailasam Memorial Award Pre-Nomination Form
An award for Innovative use of Media for Social Causes.

The award is being instituted by Cinema Rendezvous Trust to celebrate Mr. Bala Kailasam’s spirit and visions. The award will carry a citation and a cash portion.

Award will be for individuals or organisations working in any of the following platforms:

Print Media.
Social Media.

The work done by the nominee should have impacted India in a tangible manner and brought about a betterment in a society/ a state / the country.

Name of the Nominee *
Your answer
Work Being Nominated *
Title/Name of the work
Your answer
Brief writeup of the work being nominated *
(max 200 words)
Your answer
Email Address *
Your answer
Phone Number *
Your answer
IMPORTANT: This is pre-nomination ONLY. Actual Nomination should carry the following documents.
All Entries should have the below :

1. Personal Profile of the nominee.
2. Work profile of the nominee.
3. A descriptive write-up on the productive impact of the work on society, with supporting materials.
4. The nomination should be supported by articles, reports, documentaries or audio visual packages (on the nominated work and the nominee) with the clear date of publication or telecast.
5. Referrals from 2 eminent personalities.

Deadline and Detailed Nomination Submission Address
Last date for entries: 30 September 2016
For work done between: 16 Aug 2015 & 15 Aug 2016.

Send in your entries to

For more information visit

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.