1998 IAS Fellowship Elections
DECLARATION BY NOMINEE
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hereby declare that I am aware of my nomination to the Fellowship (membership) of the Islamic-World Academy of Sciences (IAS).
In case I am elected a Fellow of the IAS, I shall adhere to the Statutes and Bye-Laws of the IAS and contribute in whichever way I can to help the IAS realise its objectives of serving the humanity in the domain of science and technology for development.
Name of nominee:....…………………………………
Signature: ……...…………………………………….
Address: ……….....………………………………….
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E-mail: ......
Date: ……………………………...... ……….
Islamic-World Academy of Sciences
PO Box 830036
ZahranTelephone: +962-55 22 104, 55 23 385
Amman 11183Fax: +962-6-55 11 803
Jordan
E-mail:
CURRICULUM VITAE OF NOMINEE1
The nominating IAS Fellow should outline below reasons for his/her choice of nominee, based on:
a.The academic and professional background of the nominee;
b.Achievements of nominee in his/her specialist field; and
c.Role of nominee in the promotion of science and technology for development.
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Name of nominee:………………………………………………………...
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Justification:
Name of nominating IAS Fellow:
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1Use additional sheets where necessary retaining the order of sections and re-numbering pages as appropriate.
CURRICULUM VITAE OF NOMINEE
A-PERSONAL DETAILS OF NOMINEE
Surname or Family Name (s): …………………………………………….
Forename (s): ……………………….. Title (Dr, Prof., ...): ……………...
Country of Origin (expatriate scientists only):...... ……….….
Country of Residence: …………………………………………………….
Nationality: ………………………………………………………………..
Place of Birth:…………………………Date of Birth: ………………….
Marital Status: …………………………………………………………….
Present Position: …………………………………………………………..
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Languages: ………………………………………………………………..
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Work Address: ...... …......
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Telephone (s) : ...... ………………………………………….………….
Fax: ……...... ….. E-mail:...... ………….
Web Site Address: www……………………………..………….………..
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Home Address: ......
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Telephone: ...... Fax:......
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Countries visited (officially, study-tours, missions, conferences, privately, etc.):
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B-ACADEMIC BACKGROUND
Nominees should give names of scientists with whom they have worked.
DegreeUniversity/InstituteField Year
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BB-OTHER ACADEMIC DETAILS
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C-PROFESSIONAL EXPERIENCE(positions held and nature of work)
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CC-MAJOR CAREER OBJECTIVES
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D-MEMBERSHIP OF INSTITUTIONS & PROFESSIONAL BODIES
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E-HONOURS, PRIZES, MEDALS & AWARDS
Give details of awarding party, occasion, place and date of award.
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F-PATENTS
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G- CONFERENCES ATTENDED2(speaker, author and/or participant)
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H-SPECIFIC FIELDS OF SCIENTIFIC INTEREST
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I-PUBLICATIONS3
(a) Please give names of co-authers for joint publications;
(b)Indicate level of contribution for joint publications by adding (1-5) to the end of each listing (Principal Author = 1, Major Contributer = 2, Contributer = 3, Minor Contributer = 4, Not Applicable = 5).
(c)Indicate evaluated Papers/Articles by adding (E) to the end of each listing.
BOOKS (authored, translated, edited and/or co-edited):
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ABSTRACTS (published):
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RESEARCH REPORTS (with retrievable Reference Numbers):
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CONFERENCE PRESENTATIONS (not necessarily published):
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CITATIONS (of published work):
(a) Total number of citations:......
(b) Maximum citations of a published paper:......
Title of paper:"......
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J-ANY OTHER DETAILS
Name of nominee:....…………………………………
Signature: ……...…….……………………………….
Date: ......
(Completed form must be received byIASSecretariat no later than 1 May of the current year).
Islamic-World Academy of Sciences
PO Box 830036
Zahran Telephone: +962-55 22 104, 55 23 385
Amman 11183 Fax: +962-6-55 11 803
Jordan
E-mail:
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