International Science Community Association

International Life Time Achievement Dr. Anjani Phadnis Award -For Teaching

The International Life Time Achievement Dr. Anjani Phadnis Award – For Teaching was established in the year 2011 by International Science Community Association to honour and recognize the teachers who have made significant fundamental contributions to society over a sustained period of years and whose efforts have marked an impact in advancement of the young generation.

General terms and Conditions

  • Nominee should be an International Science Community Association Fellow Contributorand above the age of 60 years as on 31st December 2017.
  • Age certificate (copy of passport/X class school certificate/birth certificate) is required as the proof of age.
  • Main criteria for the award are based on teaching experience, contributions to the society, experimenting innovative teaching techniques etc.
  • The evaluation sheet must be filled properly and each claim should be supported by the document failing with that the award would not be considered.
  • Last date to receive the completed nomination forms is 30th September 2018.
  • Incomplete applications will be rejected without any further notice.

Complete Applications (one print copy in spiral binding + a soft copy as a single folder on CD) shall be submitted to:

Director,

International Science Community Association,

Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA.

NOMINATIONFORM 1ANOMINEE’S PARTICULARS

(In capital letters please)

Title First Name Middle Name Last Name

Name

International Science Community Association Fellow contributor No.______

Date of Birth ______

Residential Phone No. ______

Mobile No.______

Address ______

______

City ______Pin Code ______State ______

E-mail ID ______

Personal Website______

Institute ______

Current designation/Position______Type of Institute (Govt./Auto./Others) ______

Affiliated University ______

Address ______

______

City ______Pin Code ______State ______

Phone Number ______

Subject Specializations______

Overall teaching experience10-12 years21-30 years> 31 years

QUALIFICATIONS AND ACHIEVEMENTS (Please specify wherever not applicable)

Degree(s)/Diploma(s) obtained:

Degree / Name of the Institution(s) / Year attended

MORE ABOUT YOU (Attach separate sheets wherever required)

Tell us about yourself (in about 200-300 words) (You can include your hobbies, areas of interests etc.)

Why did you choose teaching as a profession?

Your students describe you as (in three words)

A day without teaching.....

One person from the field of subject who impressed you the most and why:

The way you would describe your subject to a 6 yr old:

Challenges I face while teaching subject:

The innovative ways I use while teaching subject (illustrate with examples)

I would make a difference to subject education in the future by.....

Other Membership(s)

Name of Society/ Association/Others / Position held / Duration

Honours and Awards

Name of Honour/Award / Name of Sponsoring Organization / Year

Self Development

Course/Programme / Duration
Refresher courses, Methodology workshops, Training, Teaching- Learning- Evaluation Technology Programmes, Soft Skills development Programmes, Faculty Development Programmes (Max: 30 points) / (a) Not less than two weeks duration
(b) One week duration

Participation in National/International-level Conference(s)/Seminar(s)

Name of Conference/Seminar / Role Played / Year

Participation in National/International-level project(s)/regional outreach activities/extracurricular activities

Name of Project/Activity / Location / Year

Academic/Research Projects:

Project Title / Research Sponsor / Grant Sanctioned / Period/Duration

Publication(s)

Name of article/book / Publisher / Copyright Date

Patents/Research papers published in referred journals: (do not attach research papers)

Total number of papers published If required, attach a separate sheet

Title of research paper / Journal Title / Volume/Year/Page No.

Academic contributions:

Contribution / Role Played / Period

Research Guidance

M.Phil, M.Tech. / Degree awarded only
Ph.D / Degree awarded

Have you been invited to speak on a particular topic:

Presentation/Speech Topic / Event/Location / Date/Year

Were you mentioned in the media or have you participated in education related programmes (like radio talk shows etc):

Regarding / Media / Date/Year

I certify that the information provided above is accurate. I allow the organizers of this competition to use my information and photographs for the websites, ads, brochures and other promotional collaterals in relation to the International Life Time Achievement Dr. Anjani Phadnis Award – For Teaching2016. I will abide by the competition rules and regulations and respect the final decision arrived at by the esteemed judging panels.

Signature of Applicant/Nominee......

Date......

Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA

Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: Website: