Council of Science & Technology U.P.
'VIGYAN BHAWAN'
9,Nabiullah Road,Surajkund Park,
Lucknow-226018
PROFORMA FOR SCIENTIFIC AWARDS
(Format for Vigyan Gaurav, Vigyan Ratna,Young Scientist Award)
1. Name of the award applied for :
2. Name of the Scientist / Technologist/ Engineer :
3. Date and Place of the birth (Attach photocopy for age proof) :
4. Present Position/ Designation :
5. Address with Telephone/ Fax/ Email :
a. Official Address :
b. Mailing Address :
6.. Academic qualifications (given in the form of a table from High school onwards; give particulars such as subjects, class/division, name of the Institution, year, rank/prizes etc.)
7. Positions, jobs and assignments held in chronological order
8. Current area of research (give particulars in not more than 100 words)
9. List of the publications in indexed journals (exclude presentations made in conferences/ seminars). Attach copies of not more than five outstanding publications which you consider best in the last ten years)
10. List of Patents taken
11. Details of commercialisation of the technologies developed
12. List of books/ reviews written
13. Particulars of citation index of published work in national and International journals.
14. Overseas visit (indicate the duration of the visit with dates, name of the visit with dates, name of the place and the country, purpose, supervisor if any, etc.)
15. Particulars of the memberships in Academic/ Societies/ Professional bodies
16. Awards won (give full particulars such as Agency/ Organization which gave the awards, purpose, nature of the award, its frequency etc.)
17. Significant research contributions made in the area of Science/ Technology/ Engineering disciplines during the past 10 years (not exceeding three pages) for which the Scientist / Technologist / Engineer is submitting for scientific awards to be given by CST, UP.
18. Any other information in the support of the application.
19.Certificate from three references recommending the application for the CST award(s).
20. Documentary proof for birth in Uttar Pradesh or working in U.P. for last 10 years.
| PLACE: |
Signature of the Applicant |
| DATE: |
Name and Designation |
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CERTIFICATE BY THE HEAD OF THE INSTITUTION
FOR WORKING SCIENTISTS AND STUDENTS
This is to certify that the above information given by the applicant is correct. I recommend him/ her for consideration for the "Scientific Awards Scheme - 20...... - 20....... " of the Council of
Science & Technology, U.P., Vigyan Bhawan, 9-Nabiullah road, Suraj Kund park, Lucknow-226 018.
| Place: |
Signature of the Head |
| Date: |
Name and Designation |
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