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2015 INYAS Nomination Form for New Members All applications must be supported by a letter of nomination. Applicants should request their nominators to use this form for nomination and send it directly by e-mail to chair-inyas@insa.nic.in by 11 pm IST Wednesday 30 Sep 2015. No late submissions will be considered. All responses should be in black, 12 point font. Section 1. Nominator Details Title: Full name: Affiliation and contact address: E-mail and Phone number:

Indian National Young Academy of Science

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Section 2. Applicant Details: Title:

Full name:

Designation and Affiliation: Section 3. About the applicant: Please answer each of the following questions briefly (maximum of 250 words for each answer). 1. In what capacity do you know the applicant, and for how long? 2. Please provide a brief description of your current professional position and qualifications

to evaluate candidates recognized at the national or international level?

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3. Why do believe that the applicant should be considered one of the top-ranked young

researchers at the national level?

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4. Please provide your opinion on the commitment demonstrated by the applicant to the

delivery of practical impact from their research, which might include economic, social, environmental or other benefits.

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5. Why do you feel that the applicant could both contribute towards and benefit from the

activities of INYAS?

Section 4. Declaration I declare to the best of my knowledge that the information in this application is accurate. Signed: Print name: Date: