MU 06/ KHCN

(Ban hnh km theo Quyt nh s 3839 /Q-HQGHN ngy 24 thng10 nm 2014

ca Gim c i hc Quc gia H Ni)
L LCH KHOA HC
(Dnh cho cc cn b ng k ch tr v tham gia thc hin cc
ti KH&CN ca HQGHN)

nh
3x4

1. H v tn:
2. Nm sinh:

3. Gii tnh:

4. Ni sinh:
5. Nguyn Qun:
6. a ch lin h:
in thoi: NR...........................Mobile.............................Fax:................................................
Email:
7. Hc hm, hc v:
Nm c phong GS/PGS:..................................Ni phong:............................................
8. C quan cng tc:
Tn c quan:
Phng TN, B mn, Trung tm, Khoa, Vin:
a ch C quan:
in thoi:........................................................Fax:.................................................................
Email:
9. Qu trnh o to
Bc o to

Ni o to

Chuyn mn

Nm tt
nghip

Ni o to

Thi gian o
to

i hc
Thc s
Tin s
TSKH
10. Cc kho o to khc (nu c)
Vn Bng

Tn kho o to

11. Trnh ngoi ng

Tn ngoi ng

12. Qu trnh cng tc

Thi gian
(T nm ... n nm...)

Trnh s dng
(trung bnh, kh, tt)

V tr cng tc

Chng ch
(ghi r tn chng ch)

C quan cng tc

a ch C quan

13. Sch, sch chuyn kho, gio trnh (Tn tc gi; tn sch, gio trnh; NXB; nm xut bn)
[1]
[2]
14. Cc cng trnh khoa hc cng b
14.1. S bi ng trn cc tp ch quc t ISI/SCOPUS:
14.2. S bi bo ng trn cc tp ch quc t khng thuc ISI/SCOPUS:
14.3. S bi bo ng trn cc tp ch chuyn ngnh trong nc:
14.4. S bo co tham gia cc Hi ngh khoa hc Quc t:
14.5. S bo co tham gia cc Hi ngh khoa hc trong nc:
14.6. Lit k y cc cng b nu trn t trc n nay theo th t thi gian, u tin cc dng
u cho 5 cng trnh tiu biu, xut sc nht (tn tc gi, nm xut bn, tn cng trnh, tn tp ch,
volume, trang s):
[1]
[2]
15. Bng s hu tr tu c cp:
TT

Tn v ni dung vn bng

S, K m

Ni cp

Nm cp

h
2

u
1
2

16. Sn phm c ng dng, chuyn giao:

16.1 S lung sn phm KH&CN ng dng nc ngoi:
16.2 S lng sn phm KH&CN ng dng trong nc:
16.3 Lit k chi tit cc sn phm vo bng sau:
Thi gian, hnh thc, quy m,
TT
Tn sn phm
a ch p dng

Cng dng

1
2

17. Cc ti KH&CN cc cp ch tr hoc tham gia

17.1 Nhim v KH&CN v ang ch tr

Tn nhim v/M s

Thi gian
(bt u - kt thc)

C qun qun l nhim

v, thuc Chng trnh
(nu c)

Tnh trng
nhim v
( nghim thu/
cha nghim thu/
khng hon thnh)

17.2 Nhim v KH&CN v ang tham gia vi t cch thnh vin

Tn/ M s

Thi gian
(bt u - kt thc)

C quan qun l nhim

v, thuc Chng trnh
(nu c)

18. Gii thng v KH&CN trong v ngoi nc

TT
Hnh thc v ni dung gii thng

Tnh trng
nhim v
( nghim thu/ cha nghim thu/ khng
hon thnh)

T chc, nm tng thng

3

1
2

19. Qu trnh tham gia o to SH

19.1 S lng tin s o to:..........................................
19.2 S lng NCS ang hng dn:...................................
19.3 S lng thc s o to:.........................................
19.4 Thng tin chi tit:
Tn lun n ca
H tn
Vai tr hng
NCS ( bo v
TT
nghin cu
dn
lun n TS hoc
sinh
(chnh hay ph)
ang lm NCS)

H tn thc s

Tn lun vn ca
cc thc s bo
v thnh cng)

Thi gian
o to

C quan cng tc
ca TS, NCS, a
ch lin h (nu c)

Thi gian
o to

C quan cng tc
ca hc vin, a
ch lin h (nu c)

NHNG THNG TIN KHC V CC HOT NG KH&CN

Tham gia cc t chc hip hi ngnh ngh; thnh vin Ban bin tp cc tp ch khoa hc trong
v ngoi nc; thnh vin cc hi ng quc gia, quc t; ...

H Ni, ngy ..... thng..... nm .....

XC NHN
CA TH TRNG N V

NGI KHAI
(H tn v ch k)