Nomination for Election to the Fellowship of

The Academy of Sciences, Chennai

Name of the Year of Nomination

Nominee
Address
(Official)
E Mail id Photograph of the
Contact Nominee
Number
Address
(Home)

Date of Birth Age as on 1st Jan of the year of

Nomination
Division / Biological Sciences Medical Sciences
Discipline
Mathematical Sciences Chemical Sciences
Physical Sciences Earth Sciences
Others Specify
Name and Signature of the proposer and
Address of the Date
Proposer

Name and Signature of the Seconder and

Address of the Date
Secondor

Supported by Support the nomination based on personal knowledge

1. Name: …………………………….
Signature………………………… Date

2. Name: ……………………………..
Signature………………………… Date

3 Name: ……………………………..
Signature………………………… Date
Significant
Contributions of the
Nominee in support
of the nomination
(150 words)

Important
Contributions (if
any) in promotion
of science in
Tamil Nadu
Novelty of the work
(in 50 words)

Significant 1. ..
publications to be
enclosed
2. ..

(minimum 5 )
3. ..

4. .

5. .
Nomination to be sent to the following address
The Secretary
The Academy of Sciences Chennai
Dept. Of Nuclear Physics, University of Madras,
Guindy Campus, Chennai – 600 025.

Last date for nomination: 1st January 1st July

Nominations would be valid for a period of three years.

Note : Proposer & Secondor must be the Fellow of the Academy of Sciences, Chennai

Enclosures

1. Educational Profile.
2. Scientific Career profile and Background
3. Complete list of Publications
(a) International Journals (indexed)

(b) Articles in International Periodicals / Journals (refereed)

(c) Articles in National Journals

(d) Books and Chapters (if any)

(e) Articles in the Proceedings of Conferences /Seminars/ Workshop

4. List of patents or any other Intellectual Properties (if any)

5. Activities relating to Promotion of Science in Tamil Nadu

6. Activities relating to application of science if any

7. Societal impacts of contributions if any

8. Professional Referees (Three)