ITSF

INDONESIA TORAY SCIENCE FOUNDATION

SCIENCE AND TECHNOLOGY AWARD 2012
GUIDELINES FOR NOMINATION FOR THE ITSF SCIENCE & TECHNOLOGY AWARD

1. Qualifications of Candidates The Award is open to Indonesians residing in Indonesia and pursuing research in the field of Science & Technology, excluding mathematics, clinical medicine, and social sciences, who had made a significant breakthrough to scientific knowledge. 2. ITSF Science & Technology Award The ITSF Science & Technology Award for 2012 will consist of a certificate and a prize of Rp. 75 millions. 3. Nomination of Candidates A candidate should be nominated by a representative of a scientific research institution or an institution of higher learning. No direct application of candidates will be considered. The representative of the nominating institution is encouraged to proactively seek suitable candidates and provide sufficient justification for the nomination. The representative should be the Chairman of the Research Institute / The Dean of the Faculty of a University or The Director of a Research Center for nonuniversity institutions. 4. Nomination Procedure Candidates should complete the nomination form supplied by ITSF and send 5 (five) copies of the completed form including any attachments after nicely bound with a transparent plastic cover to ITSF at the mailing address stated herein. 5. Deadline The completed forms should reach the foundation on or before 31 August 2012. 6. Selection Mechanism The awardee will be selected by the following Selection Committee members: Dr. Suwarto Martosudirjo, APU Dr. Debbie S Retnoningrum Prof. Dr. Ir. Dedi Fardiaz, M. Sc Experts outside the selection process. Selection (Chairman) (Member) (Member) Committee may be requested to assist in the

An interview of short listed candidates may be carried out. The decision of the foundation is final and no correspondence regarding the decision will be entertained.

7. Presentation of the Award The presentation ceremony for the ITSF Science and Technology Award for 2012 is scheduled for February 2013. Notes: a) Candidates need not necessarily be a member of the nominating institution. b) Please write e-mail, phone or fax to ITSF at the address/numbers stated below for additional information and clarification. c) The Award is not taxable on part of the awardee.

Mailing Address/Enquiries to: INDONESIA TORAY SCIENCE FOUNDATION Summitmas II - 3rd Floor Jl.Jenderal Sudirman Kav. 61-62 Jakarta-12190 Indonesia Tel: (021) 5220785, 2526841 Fax: (021) 5202041 E-mail: itsf@ina.toray.co.id Homepage: http://www.itsf.or.id

ITSF
INDONESIA TORAY SCIENCE FOUNDATION

AWARD 2012 19th

NOMINATION FORM SCIENCE AND TECHNOLOGY AWARD

DATE TO : : INDONESIA TORAY SCIENCE FOUNDATION Summitmas II 3rd Floor Jl. Jenderal Sudirman Kav. 61-62 Jakarta Selatan 12190 Tel : (021) 5220785, 2526841 Fax : (021) 5202041 Homepage : http://www.itsf.or.id Email : itsf@ina.toray.co.id

(This form should be completed, typed or printed in English. Use a separate form for each nomination. You need not use this form if you can re-produced and complete it in the same format using a photocopier or a word processor).

Please read the guidelines and this form carefully before you fill in the form. Failure in submitting necessary attachment will result in the nomination not being considered. A recent photograph of the candidate should be attached. The proposal with all necessary attachments should be nicely bound with transparent plastic cover, and send 5 (five) copies to ITSF at the mailing address stated herein. Particulars of Nomination Institution Name of Institution :
(should be a Researcher Center or a Faculty for University or a Research Center (Puslit) for Non-university institution)

Address Province Telephone Email address

(Chairman/Dean/Director)*
*) choose the appropriate one

: : : (..) : Post Code: Fax: (..)

Name & Title of Representative :

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I nominate this candidate for the ITSF Science & Technology Award on the basis of the following contribution of the candidate, leading to a significant breakthrough in his/her field of study.

(
Signature of the representative of the nominating institution

)
Date

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PHOTO Size 4x6 should be attached here

PARTICULARS OF CANDIDATE
Name & Title Place & Date of Birth Sex Name of Institution Position of Candidate Address of Institution Province Telephone Home Address : Province Telephone Handphone : : (..) : : Post Code Fax Email : (..) : : : : : Male : : : : : () Post Code Fax : (..) : Female

Field of Focus Research

Title of the Research Area

Summary of research (in ordinary language) max 100 words - Key technology : - Purpose : - Result : - Impact :

( Signature of the Candidate

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Please state whether any award has been received within the last two years: Yes: If yes, When From Type of Award Rp/US$ : : : : / No:

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Detailed description of contribution to scientific knowledge leading to a significant breakthrough in the field of study (Please provide sufficient and clear information for an objective evaluation by an informed reviewer if necessary, please use additional pages).

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Detailed publications related to the above achievements Please list the publications in the following format: Author(s); Year; Title of Article; Name of Scientific Journal; Volume, and page numbers Data on citation index of your publications will be helpful for quality assessment of the publications. Please indicate minimum 2 (two) of main publications (marked by an asterisk) and submit 1 (one) copy each of two main publications and bound to the proposal. Failure to do this may result in a non-consideration of the nomination.

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Biodata of the Candidate Please include information regarding the educational and research experiences. The degree(s) obtained should be mentioned in detail including the year and the place/university. Please include also the title(s) and a copy of the thesis and or dissertation.

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