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The 5th BRICS Young Scientist Forum



 

Nominee’s Photo
                                  

The 5th BRICS Young Scientist Forum

 Russia

September 2020

NOMINATION FORM FOR THE 3rd

 BRICS YOUNG INNOVATOR PRIZE

[..Name of the BRICS Country..]


REQUIRED DOCUMENTS:

1) Nomination form;

2) Nominee’s Curriculum Vitae/brief Biography;

3) A photo of nominee (image must be larger than 250*300 pixels)

THE DEADLINE: 10 August 2020

 

 


NOMINEE’S DETAILS/INFORMATION

BRICS Country:

Last Name: First Name:
Date of Birth (Day/Month/Year): Passport Number: ….. (Date of Issue: ….. and Expiry Date:…………)

Address:

Telephone: Email:
Title: Gender:

Institution/Affiliation:

Field of Science and Technology:

ACADEMIC QUALIFICATION(please tick where appropriate)

Bachelors   Masters   PhD   Other  

 

Nomination Statement (up to 300 words):Please describe area of expertise in which the nominee has demonstrated innovation excellence. Please information in English.
 
Innovative Project Statement (up to 300 words):Please provide brief information on the nominee’s innovative idea. Please information in English.
 
Participation in Innovation Competitions/Awards/Achievements:Please list previous participation in innovation competitions and awards/achievements, if any. Please provide information in English.
   

DECLARATION BY THE CANDIDATE:

I hereby declare that all the information given above is true to the best of my knowledge. Further, in the event of being selected, I undertake to accept the offer to participate in the 4th BRICS Young Scientist Forum in Brazil, and will attend the full programme of three days and will not seek any personalised programme during the visit.

 

PLACE:                           

 

 

DATE:                                           SIGNATURE OF THE NOMINEE:                            

 

 

NAME OF THE NOMINATING AUTHORITY(with contact details, i.e. telephone, email and designation)

 

 

PLACE:                           

 

 

DATE:                                           SIGNATURE:                                                            

 

NB: Remember to include the following on the Nomination Form:

· Nominee’s Curriculum Vitae/Biography

· Photo of nominee (image must be larger than 250*300 pixels)



  

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