THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, INSTITUTIONAL AREA, LODI ROAD, NEW DELHI 110003
NOMINATION FORM FOR IETE AWARDS-2008


              

Name of the Award : 


                              

1.     NAME OF THE NOMINEE (as it appears in official records)  __________________________________

Present occupation (Position, organization)______________________________________________

     Office Address (including fax and e-mail)     ______________________________________________
                                                                                              
     ______________________________________________________________________________          
   

 Residential Address__________________________________________________________________

_________________________________ __________________________________________________

Phone No. (O)__________ (R )___________Mobile No___________ Fax No._________e-mail________

      Age and Date of Birth__________________________________________________________________

  1. (a) Education

                    Degree                                               Year                                         University / Institution





(b)       Membership of Professional Society(ies) with category of membership               

   (i)

   (ii)

   (iii)

 

 

  1. PROPOSED CITATION (not more than 50 words highlighting the nominee’s significant contributions).










  2. PROFESSIONAL EXPERIENCE OF NOMINEE (Present position first; please limit to space, attach annexure, if required).


 

 

 

 

 

  1. CONTRIBUTION OF THE NOMINEE (not more than 200 words together for (a) and (b) )

    a)   Identify the most significant contribution which qualifies the nominee for the IETE award. Choose one of the following and explain.

Engineer/Scientist 

Educator

Tech Manager

Any other
(please specify)
















b)  Explain how the contribution of the nominee will have potential significant impact on the future developments in India in the respective fields recognized for the award.


 

 

 

6.                  SCIENTIFIC/TECHNICAL ACHIEVEMENTS OF THE NOMINEE, such as scientific/ technical publications, reports, and presentations, patents, development of products, applications and systems, application of facilities, services etc in appropriate period mentioned in description of that award (please
 limit to the space provided)



          a) Nominee’s three most important achievements and their engineering /social significance:



























b) List not more than ten additional achievements, if any, and identify their importance where possible.

 



c) List of Publications in the last ten years (Please attach separately giving Name(s) of author(s), Title, Journals.  Volume, Pages and year for papers and relevant details for Books /Reports etc (Copies of publications need not be sent.))

7.         AWARDS RECEIVED BY THE NOMINEE, if any

                Name of Award                                                                                            Year







8.         REFERENCES - Names and addresses of two Referees, who may be contacted for further information.
 
a)            Name                                                        b)           Name    
 
               Address                                                                   Address   
 
               Telephone  ___________  e-mail _____________Telephone ____________ e-mail  _______
 

9.         Handicapped status of nominee, if any: (Enclose authenticating documents)



10.     Has the nominee been awarded any IETE award during the last 3 years, if yes, details:

Name of the Award                                                      Year

a)

b)

c)

Note: A Nominee is ineligible if he / she has received any of IETE awards during the last three years.

  

 

 

11. I do hereby give my consent for this nomination and certify that this work has not  
      received national or international award till date.






                                                                                                          Signature of nominee



12.  NOMINATOR

       Name___________________________________________________________________

      Address_________________________________________________________________

       ________________________________________________________________________
 
      Telephone_____________Mobile No_____________e-mail______________________



      Date________________________                       Signature_________________________