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
Contributor and above the age of 60 years as on 31st December 2015.

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 2016.

Incomplete applications will be rejected without any further notice.
Complete Applications (one printed copies + 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.
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
International Science Community Association
International Life Time Achievement Dr. Anjani Phadnis Award
- For Teaching
NOMINATION FORM 1A NOMINEE’S PARTICULARS
Please tick according to the level you
are teaching
(In capital letters please)
Class XI and XII
Graduate Level
Photo
Post-Graduate Level and
Title
First Name
above
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 experience
10-12 years
21-30 years
> 31 years
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
International Science Community Association
International Life Time Achievement Dr. Anjani Phadnis Award
- For Teaching
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:
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
International Science Community Association
International Life Time Achievement Dr. Anjani Phadnis Award
- For Teaching
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
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
Duration
International Science Community Association
International Life Time Achievement Dr. Anjani Phadnis Award
- For Teaching
Honours and Awards
Name of Honour/Award
Name of Sponsoring Organization
Year
Self Development
Course/Programme
Duration
Refresher
courses,
Methodology (a) Not less than two weeks duration
workshops, Training, Teaching- LearningEvaluation Technology Programmes, Soft
Skills development Programmes, Faculty (b) One week duration
Development Programmes (Max: 30
points)
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
Publication(s)
Name of article/book
Research Sponsor
Grant Sanctioned
Period/Duration
Publisher
Krishnaashraya, 427, Palhar Nagar, RAPTC, VIP-Road, Indore-452005 (MP) INDIA
Phone: 91-731-2616100 Mobile: 91-9302232884, E-mail: contact@isca.in Website: www.isca.in
Copyright Date
International Science Community Association
International Life Time Achievement Dr. Anjani Phadnis Award
- For Teaching
Patents/Research papers published in referred journals: (do not attach research papers)
Total number of papers published
Title of research paper
Academic contributions:
Contribution
If required, attach a separate sheet
Journal Title
Volume/Year/Page No.
Role Played
Period
Event/Location
Date/Year
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
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 Teaching 2016. 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: contact@isca.in Website: www.isca.in