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APPLICATION FOR BEST EXTENSION SCIENTIST AWARDS

|Name |: |Dr/Mr/Ms. |

|Date of Birth & Age |: | |

| | |(Enclose Proof of Age – Birth Certificate or Matriculation Certificate) |

|Nationality |: | |

|Designation |: | |

|Qualification |: | |

|Specialization | | |

|Address |: | |

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|Email address |: | |

|Phone number |: | |

|Total Impact Points obtained |: | |

|(Thomson Reuters) | | |

| | |(Enclose the research publications and its list with latest impact factor (as |

| | |per the annexure -1)) |

|No. of patents | |Attach the list with the proof |

|No. of conference/ workshop/ seminar | |Attach the list with the proof |

|conducted | | |

|No. of project handled as PI | |Attach the list with the proof |

|Training Program /workshop/ farmers meet | |Provide details in annexure |

|organized | | |

|Total number of farmers trained | |Provide details in annexure |

|Any transfer of technology | |Provide details in annexure |

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1. Salient contribution made by the candidate in respective field (200 words)

2. Oral presentation

a. Topic:

b. Abstract (250 words)

c. Oral presentation marks obtained (Given by the expert panel- official purpose) :

I certify that the information provided above is true and correct to the best of my knowledge. I am agreeable to the terms and conditions of the award. I undertake to abide by the decision of the expert committee, juries and Society of Fisheries and Life Sciences in the matter of the above competition.

Place: ………………………… Signature: …………………..

Date:………………………… Name: ………………………

Endorsement/Recommendation from the Head of the Department/ Institute where the applicant is employed.

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………

Date: ……………….. ……………………

(Signature of Head of Institution)

Place: ……………….

ANNEXURE -01

PUBLICATIONS

|Sl..No. |Title of the research paper (Full) |NAAS Rating |Total Impact Points obtained |Link/URL/DOI no of the manuscript |

| |Authors name (only first three authors or corresponding author) (Bold the applicant name | |(Thomson Reuters) | |

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|Total NAAS rating/ Impact Points | | |

I do hereby declare that information furnished in this Application Form and information furnished above is true to the best of my knowledge and belief. In case if the information is proved to be false, my candidature can be cancelled.

Place:

Date: Signature of the applicant[pic]

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