International Science Community Association International Best Teacher Award The International Best Teacher Award 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 55 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 Best Teacher Award NOMINATION FORM 1A NOMINEE’S PARTICULARS (In capital letters please) Please tick according to the level you are teaching Class XI and XII Graduate Level Photo Post-Graduate Level and above Title First Name Middle Name Last Name Name International Science Community Association Fellow Contributorship 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 Best Teacher Award 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 Best Teacher Award 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 Best Teacher Award 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 (b) One week duration Skills development Programmes, Faculty 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 Patents/Research papers published in referred journals: (do not attach research papers) 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 Best Teacher Award Total number of papers published Title of research paper Academic contributions: Contribution 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 If required, attach a separate sheet Journal Title Volume/Year/Page No. Role Played Period 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 Best Teacher Award 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