Indian national science academy bahadur shah zafar marg, new delhi-110002

INDIAN NATIONAL SCIENCE ACADEMY

BAHADUR SHAH ZAFAR MARG, NEW DELHI-110002

Nomination Form for Election as Pravasi Fellow

(All entries in the Nomination Form should be completed, preferably typewritten)
The undersigned Fellow of the Indian National Science Academy proposes:

as a candidate for election as a Pravasi Fellow of the Academy (Details of qualification, achievement etc. are given on next page alongwith brief biodata).

Date: Signature of the Proposer __________________
Name __________________________________

FOR OFFICE USE

Date of Receipt

Registration No.

Executive Director
Space for brief information about the nominee
1. Name in Full:
2. Date of Birth:
3. Nationality:
4. Is the nominee a PIO/OCI Card holder ?

(If yes, please provide a copy)

5. Profession, Rank and Present Address:

6. No. of years of active research in the country of nominee’s stay:

7. Permanent Address:
8. E-mail:
9. Tel:
10. Qualifications and Distinctions:

11. Field of Specialization:

12. Please indicate if the nominee is a

Fellow of the National Academy in

his / her Country:

13. Brief statement, in about 200 words, regarding the major scientific and technology achievements and breakthroughs of the Nominee which in the opinion of the Proposer should be circulated for information to the Fellowship:

14. Statement of the nominee’s interaction with scientific institutions and activities in India:

15. How would nominee’s election help the Academy in the furtherance of the aims and objectives of the Academy.

16. Please enclose brief biodata of the Nominee including:

(a) Total 10 best papers as identified by the nominee

(b) List of papers published in preceeding five years

(c) Total list of publications
17. Please provide pdf of full text of 5 best papers of the nominee.

18. Please provide name and contact details of at least three Indian scientists working in India with whom the nominee has close professional linkages:

a)

b)

c)