For membership

FOR MEMBERSHIP

THE NATIONAL ACADEMY OF SCIENCES, INDIA (NASI)

5, Lajpatrai Road, ALLAHABAD – 211 002, India

Proforma of Nomination Form for the Membership*
(All entries in the nomination form should be typed without making any reference

such as ‘Please see enclosure/biodata etc.’)
The last date for receiving completed nomination form in the Academy

is 15^th February every year
The undersigned Fellows of the National Academy of Sciences, India propose and second the name of :
Prof./Dr./Shri ………………………………………………………………………………………………
for the membership of the Academy.
1. Proposer’s Name :

Place :
Date : Signature of Fellow, NASI

2. Seconder’s Name :
Place :
Date : Signature of Fellow, NASI

*Eligibility Criteria

1. 
   High academic qualifications in any discipline of Science and Technology e.g. Ph.D., D.Phil., M.Tech., M.D., M.S., and equivalent qualifications.
   
2. 
   Evidence of active involvement in Science and Technology activities
   
3. 
   Documented evidence of high quality of research publications in peer reviewed national and international Journals and/or evidence of exceptional ability as a teacher or involvement in ‘Science Promotion’/’Popularization Programs’.
   

Note: While nominating a scientist to the Membership of the Academy, proper attention is to be given to

nominate only those who are not engaged in unethical behavior.

1. 
   Name in full : _______________________________________________
   

Surname Forename(s)

2. 
   Designation and :
   

Name of the

Institution

3. 
   (a) Date of Birth : (b) Gender : Male / Female
   

4. 
   Nationality :
   

5. 
   Address
   

Official _______________________________________

_______________________________________
_______________________________________

Residential _______________________________________

_______________________________________
_______________________________________

Tel.No………………………………………………………………….

Fax No…………………………………………………………………
Email…………………………………………………………………..

6. 
   Educational Qualifications :
   

Degree/Diploma University/Institution Year

__________________________________________________________
__________________________________________________________

__________________________________________________________

__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

7. 
   Significant research contributions (Not exceeding 200 words).
   

8. 
   Special contributions to teaching, promotion and management of science.
   

9. 
   Complete list of research publications, in refereed Journals only, including those accepted; and Books, Monographs etc. (Please give names of all the authors, year, title, name of the Journals, volume, page no.). Attach reprints of up to three important research papers.
   

10. 
    Any other information e.g. Fellowship/Membership/Awards and achievement in any other field like arts, popular articles, sports etc.
    

SUMMARY

(All entries should be typed without making any reference such as ‘Please see enclosure/biodata etc.’)

1. Name in full : __________________________________________________

Surname Forename(s)

2. 
   Designation and :
   

Name of the

Institution

3. 
   Date of Birth : Gender : Male / Female
   

4. Significant research contributions (not exceeding 200 words)

5. Special contributions to teaching, promotion and management of science.

6. List of ten best research publications, in refereed journals only, including those accepted; and Books, Monographs etc. (Please give names of all the authors, year, title, name of the Journals, volume, page no.). Attach reprints of up to three important research papers.

7. Fellowship/Membership/Awards and achievements in any other field like arts, popular articles, sports etc.