1

Nomination Form for ISESCO Prizes in Sciences and Technology2016

Duly completed Nomination Form is to be mailed through the National Commission of your Country:

to : ISESCO Centre for Promotion of Scientific Research (ICPSR)

Islamic Educational, Scientific and Cultural Organization (ISESCO)

Avenue des F.A.R , Hay Ryad, PO Box 2275

P.C. 10104 - Rabat - Kingdom of Morocco

Tel.: + 212 (0) 5 37 56 60 52 / 53

Fax: + 212 (0) 5 37 56 60 12 / 13

E-mail: ,

URL:

The following nomination is for ISESCO Prize in the field of (please tick the appropriate box)

Biology / Chemistry / Geology / Mathematics / Physics / Technology

I- CANDIDATE

Family name: / Given name: / Position / Title:
MemberState: Nationality: Marital Status:

Gender: Male Female day month year
Correspondence Address / Nominating Institution Address
Current Designation: Since:
Address:
City: Zip code:
Country: / Name of Institute:
Address
City: Zip code:
Country
Telephone: / Telephone:
Fax n°: / Fax n°:
E-mail: / E-mail:

Please attach with Nomination Form: Brief biographical sketch including major accomplishments, provide the 1st page of the offprint of 5 recent significant research papers, complete list of publications, and Curriculum Vitae.

II- DEGREES & DIPLOMAS

Degree / Name & address of University / Starting year / Awarding year / Discipline

III- RESEARCH OUTPUT

Number of publications (1) / Patents (2) / Number of manuals & books published (3) / Number of students supervised
(Theses or Monographs defended, provide the thesis’s flyleaf or administrative certificate) / Number of international meetings attended
National / International / Ph. D. / M. Ph.

(1) Publications in journals indexed in ISI database, or in other scientific peer-reviewed journals, provide the 1st page of the offprint; specify the corresponding website

(2) Specify the type of patent, Give the exact patent references, and specify the corresponding website

(3) Provide the flyleaf, summary of the book, publishing house, ISBN/ISSN

IV- AWARDS / NATIONAL AND INTERNATIONAL DISTINCTIONS

(Do not mentionthe scholarships;it’s about awards anddistinctionsforscientific merit)

Category / Name / Country / Year awarded

V- DETAILS OF 5 RECENT SIGNIFICANT RESEARCH PAPERS (RP)

Title of RP / Language / Year of publication / Reviews / Journals in which RP published

VI- EMINENT PERSONALITIES FAMILIAR WITH THE CANDIDATE'S WORK

N° / Name, Title & current Position / Name of City & Country / Full Address
1
2
3

VII- SCIENTIFIC RESPONSABILITIES

VIII- SIGNATURES

I certify that information provided in this is accurate and complete

Endorsement by the Head of Nominating Institution

Endorsement by the Head of the National Point of Contact (NPC) of ISESCO in the country

You are requested, if possible, to send us one (or more) recommendation letter (in English-Arabic-French) specifying the nature of the subject in relation to the national priorities and the impact of your work on the socio-economic field.

(Applications received after 31-03-2016 will not be entertained)