SCIENCE AND TECHNOLOGY AWARD

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ITSF INDONESIA TORAY SCIENCE FOUNDATION SCIENCE AND TECHNOLOGY AWARD 2016 GUIDELINE 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, who had made a significant breakthrough to scientific knowledge, contributed to the development of science and technology in Indonesia. Please note that mathematics, clinical medicine, and social sciences are excluded. The evaluation will be based on the scientific breakthrough with the following supports: a. Consistency in conducting researches in the same field. b. Number and quality of publications in peer reviewed journals. c. The quality of journal where the research works published. d. The independence of research works (in contrast to the supervised works). e. Other kind of scientific contributions (patents, technology applications, etc). f. Scientific attitude. 2. ITSF Science & Technology Award The ITSF Science & Technology Award for 2016 will consist of a certificate and a prize of Rp. 100 millions. 3. Nomination of Candidates A candidate may nominate himself/herself and send the completed nomination application directly to ITSF. A candidate may also be nominated by a representative of a scientific research institution or an institution or a higher learning institution. The representative of the nominating institution such as the Director of Research Institute/Center or the Dean of Faculty in a University is encouraged to proactively seek suitable candidates and provide sufficient justification for the nomination. 4. Nomination Procedure Candidates should complete the nomination form supplied by ITSF and send 5 (five) copies of the completed form including any attachments 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 2016. 1

6. Selection Mechanism The awardee will be selected by the following Selection Committee members: Prof. Dr. Ir. Dedi Fardiaz, M. Sc Dr. Debbie S Retnoningrum Prof. Dr. Anung Kusnowo (Chairman) (Member) (Member) The Selection Committee may request experts in the relevant field to assist the selection process. 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 program 2016 is scheduled on February 2017. Notes: a) Please send e-mail or fax to ITSF at the address below for additional information and clarification. b) The Award s tax will be bourne by ITSF. INDONESIA TORAY SCIENCE FOUNDATION Summitmas II Building - 3 rd 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 2

ITSF INDONESIA TORAY SCIENCE FOUNDATION AWARD 2016 23 rd DATE : NOMINATION FORM SCIENCE AND TECHNOLOGY AWARD TO : INDONESIA TORAY SCIENCE FOUNDATION Summitmas II Building 3 rd 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 can re-produce and complete the form in the same format). P Please read the guidelines carefully before you fill in the form. Failure in completely filling the application form and submitting necessary attachments will result in the nomination not being considered. Five (5) copies of the proposal with all necessary attachments bound with transparent plastic cover, should be send to ITSF. Name of Institution : (the Director of Research Institute/Center or the Dean of Faculty in a University) Address : Province : Post Code: Telephone : (..) Fax: (..) Email address : Name & Title of Representative : (Chairman/Dean/Director) 3

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 4

PARTICULARS OF CANDIDATE Name & Title : Place & Date of Birth : Age : Sex : Male Female PHOTO Size 3x4 should be attached here Name : of Institution Faculty : Dept : Position : of Candidate Address : of Institution Province : Post Code : Tel. No : (..) Fax. No : (..) Mobile No. : Email : Field of Focus Research : Title of the Research Area : Please summarize your scientific breakthrough in maximum 100 words which covers the followings: - Key technology : - Purpose : - Result : - Impact : ( ) Signature of the Candidate 5

PREVIOUS ACHIEVEMENTS Please, state whether any award has been received within the last two years: Yes: / No: If yes, When : From : Type of Award : Rp/US$ : 6

Please describe your detailed contribution to scientific knowledge leading to a significant breakthrough in your field of study, include abstract, method, and achievement. The nomination will not be considered if you fail to submit the above requirement. 7

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. The nomination will not be considered if you fail to submit the above requirements. 8

Candidate Curriculum Vitae Please include information regarding the educational and research experiences. The degree(s) obtained should be mentioned in detail including the title(s), the year, and the place/university. If necessary, attach the copy of the thesis and or dissertation. 9