Application for

Best Woman Professional Award 2024

1. IEEE Membership Details

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IEEE Membership Number *

Current IEEE Member or should have been an IEEE Member for a duration of 1 year at least within the previous 3 years (before the month and year of commencement of application).

Attach Membership Card *

Click or drag a file to this area to upload.

.jpeg, .jpg, .png, or .pdf files only, less than 1mb.

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Member since - Month *

Month

Member since - Year *

Year

2. Personal Details

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Name of Nominee *

Email *

Confirm Email

Phone number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

3. Nationality

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Country *

Document *

Attach Here *

Click or drag a file to this area to upload.

.jpeg, .jpg, .png, or .pdf files only, less than 1mb.

4. Education

a. Undergraduate Degree

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Name of Degree *

Specialization *

Name of the University *

Passing Year *

Marks (Consolidated GPA / Percentage) *

b. Post Graduate Degree (if applicable)

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Name of Degree *

Marks of First Year (Consolidated GPA / Percentage) *

Name of the University

Passing Year

Marks of Second Year (Consolidated GPA / Percentage) *

c. PhD Studies (if applicable)

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PhD Domain

University / Institute

Ph.D. research started

Commencement

Month

Year

Topic of Research

Ph.D. degree awarded / Defence Completed

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Month

Year

d. Post-Doctoral Research (if applicable)

Duration

Post-Doc From

From

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Institute/ Organisation

Institute/Organisation where Post Doctoral Research was pursued.

Funding Agency

Domain

5. Co-curricular/Extra-Curricular Achievements (copy)

Co-curricular Achievements – Please list down your top achievements (maximum 5) *

Extra - curricular Achievements – Please list down your top achievements (maximum 5) *

6. Work Experience (Including research)

Total Work Experience (Years)

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Current Position / Designation held *

Name of the Institute / Organization *

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Current Position / Designation held since

Current Job Profile (in brief) *

Work Experience Certificate (current position) *

Click or drag a file to this area to upload.

Attach bonafide letter from institute/organisation mentioning duration of employment and designation

Same as previous

Select if previous position/ designation is same as current position

Previous Positions

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Previous Position / Designation held

Name of the Institute / Organization

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Date of joining

Date of leaving

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Relieving Letters

Click or drag files to this area to upload. You can upload up to 10 files.

Attach relieving letters/experience certificates for previous positions/designations held (jpg, png, or pdf format)

7. Professional Achievements in the last 3-5 years (including entrepreneurial / leadership / organizational achievements)

Please list down your top achievements (maximum 5) *

8. Research

Total no. of Research Papers Published

Details of Research

Title

Authors

Names of Authors separated by comma

Published in

Journal

Conference

Book

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Total no. of Patents Granted

Details

Please include only those patents that have been granted or published (do not mention patents that have been applied).

Total Number of Sponsored Research/ Projects

List of Sponsored Research/ Projects

Multiple Choice

Research
Project

Duration

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From

Title

Name of PI

Institute/Organisation

Institute/organisation where research/project is being conducted

Funding Agency

Domain

Add more...

9. Contributions towards organization / community / society / nation

List Your Contribution Towards Technical Development (in about 150 words) *

List Your Contribution Towards Social / Economic Development (in about 150 words) *

10. Recommendation 1

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Name of person recommending *

His / Her Designation *

Organization where he / she works *

His / her contact number

His / her email id *

Recommendation Letter (Scanned Copy)

Click or drag a file to this area to upload.

Max File Size : 1 MB

Recommendation letters can also be mailed directly by the Referee to info@hfrc-ieeeawards.org

Tick box to state that we can contact the person for verification *

I agree
I do not agree

11. Recommendation 2

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Name of person recommending *

His / Her Designation *

Organization where he / she works *

His / her contact number

His / her email id *

Recommendation Letter (Scanned Copy)

Click or drag a file to this area to upload.

Max File Size : 1 MB

Recommendation letters can also be mailed directly by the Referee to info@hfrc-ieeeawards.org

Tick box to state that we can contact the person for verification *

I agree
I do not agree

Statement of Worthiness & include how the prize money would be used (200 words) *

Please upload certificates/credentials that validate your academic, co-curricular, and extracurricular achievements. The files can be in jpg/pdf format only. Recommendation letters/experience certificates or other content in MS Word files may be scanned and converted to jpg/pdf and then uploaded. Each file being attached should not be more than 1 MB.

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Consolidated Degree Marksheet *

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Degree Certificate *

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Consolidated Master Degree Marksheet

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Master Degree Certificate

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Masters - Year 2

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Any Additional Certificates

Click or drag files to this area to upload. You can upload up to 10 files.

If any additional file / credential needs to be shared with the Award committee, please mail it to info@hfrc-ieeeawards.org

Declaration: I hereby declare that the particulars furnished by me in this nomination / application form are true and correct to the best of my knowledge and belief. In case any information is found to be incorrect / false, my candidature shall be liable to be rejected. *

I Agree

Phone