NOMINATION FORM FOR FELLOWSHIP OF IAAVR
Instruction: Please go through the enclosed Yellow Score Card and then fill up the
nomination form. After completion of the nomination form, complete your score card (self
assessment) and attach with this nomination form
1.
2.
3.
4.
5.
6.
Name (Full Capital Letters)
Father’s Name
Date of Birth
Age as on 31.12.2008
Permanent Address
Correspondence Address
if different from No.4
:___________________________________________________
:___________________________________________________
:
:___________________________________________________
:___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
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Telephone nos
:
STDCode____________ (O)__________®______________________Mb_______________________
E-mail:______________________________________________________________________________
7. Qualification [Attach a Xerox copy of degree certificate]
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Sl. No.
Degree
University/Institution
Year
Ran/Div/OGPA
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1.
BVSc &AH
2.
MSc
3.
MVSc
4.
PhD
5.
DSc
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8. Experience: Scale of Pay [Choose the present Scale]
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Sl.
Scale of Pay with experience
Experience
Total
No.
From
To
years of
experience
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1.
Rs.8000-10000 or equivalent with 5 yrs
experience
2.
Rs.10000-12000 or equivalent with 5 yrs
experience
3.
Rs.12000-18000 or equivalent with 5
yrs experience
4.
Rs. 16400-22400 or equivalent with 5 yrs
experience
5.
Rs. 16400-22400 or equivalent or above scale
with 10 yrs experience
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4. Awards [Attach Xerox copy of award certificate]
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Sl. No. Name of Award
Awarding Agency
Year of Award
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1.
2
3
4.
5.
6.
1
7.
8.
9.
10
11.
12.
13.
14.
15.
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5. Fellowships [ Attach certificate of conferred fellowships]
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Sl. No. Name of Award
Awarding Agency
Year of Award
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1.
FNAVSc
2
FNAASc
3
FNASc
4.
FASc
5.
FNA
6.
Society Fellowship
7.
Society Fellowship
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6. Foreign Visit [Choose and Tick only one Visit] (Attach evidence)
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Sl. No.
Foreign visit
Tick appropriate
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1.
Foreign visit upto 3 months
2.
Foreign visit upto 6 months
3.
Foreign visit upto 9 months
4.
Foreign visit upto 12 months
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7. National Fellowships [Tick appropriate Fellowships] (Attach evidence)
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Sl. No.
National Fellowships
Tick appropriate
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1.
INSA Visiting Scientist Fellowship 3 months
2.
DST SERC Visiting Fellowship 3 months
8. Administrative Experience (Attach evidence) [Tick the one experience of highest position)
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Sl. No.
Administrative Exerience
Tick appropriate
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1.
Dean or Associate Dean
2.
Vice Chancellor
3.
Director of National ICAR Institutes/DDG
4.
Animal Husbandry Commissioner
5.
Director of ICAR Institutes
6.
Advisor to Govt. Deptt
7.
ADG ICAR or PD ICAR or JD National Insttt or Dean PG
8.
Director State Govt AH Deptt
9.
Head of National ICAR Insttt or Head of University levels
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9. Research Publications 10 Top with weightage of not less than 2.5 assigned by NAAS
Attach list of Publications as Annexure-I
10. Other Research Publications maximum list of 50- Annexure-II
11. Office bearer of societies etc [One time claim for one item] (Tick one) [Attach Proof]
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Sl. No.
Officer bearer
Tick appropriate
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1.
President/Vice-President of Society
2.
Secretary/Joint-Secretary
3.
Treasurer
2
4.
Member Executive Commitee
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12.
Office bearer of journals etc [One time claim for one item] (Tick one) [Attach Proof]
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Sl. No.
Officer bearer
Tick appropriate
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1.
Founder Editor/Chief Editor/Editor
2.
Associate Editor/Co-editor
3.
Member editorial board
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13. Popular and Technical Papers maximum 50- Attach list-Annexure-III
14. Books
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Sl. No. Title of Book authored with name of authors
Year of Publication;
Name of Publisher
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1.
2.
3
Title of Book edited, name of editors
Publisher
1.
2.
3.
4.
5.
Year of Publication,
Chapter to books only. Title of chapters, authors
Year of publication,
Name of book published
1.
2.
3.
4.
5.
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15. PATENTS [Attach Proof]
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Sl. No. Title of Patent
Year of Patent
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1.
2.
3
4.
5.
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16. TECHNOLOGIES DEVELOPED (Attach Proof)
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Sl. No. Details of Technology
Year of Commercialization
of Technology
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1.
2.
3
4.
5.
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17. Radio Talks Maximum 10 items-Attach a list Annexure-IV
18. Students Guidance
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Sl. No.
Title of Thesis & Year
Name of Student
Subject/Discipline
3
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MVSc
1.
2.
3.
4.
5.
PhD
1.
2.
3.
4.
5
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19. Extramural funding project awarded by DBT/ICAR/ICMR/CSIR or any other agency
[Claim one Project] Refer Score Card
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Sl. No. Title of Project
PI or
Awarding
Year of
Cost of
Co-PI
agency
Award
Project
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20.
Life Membership of IAAVR : Yes/ No
21.
Participation in IAAVR Conferences
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Sl. No. Details of Participation in IAAVR Conference
Year of Participation
Attach Participation Certificate
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1.
22.
Contribution to IAAVR or other Societies
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Sl. No. Details of Contribution
Year
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1.
Organizing Secretary, IAAVR Conference
2.
Joint-Organizing Secretary, IAAVR Conference
3.
Organizing or Co-organizing Secretary, other Societies
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23. Details of Participation in two (outside India) International/Foreign
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Seminar/Conferences attended within last 10 years (Attach Participation certificate)
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1.
2.
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24. Overall assessment marks to be given by IAAVR
Note: Attach a copy of Full bio-data
Date:
Signature of Candidate
4
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