Nomination Format

This format should NOT be used as a substitute for the online Nomination Form. Nomination received in any way other than a submission of the Online form will be summarily rejected. The format below indicates the details required for filling out the Nomination Form.

Please have all the details in hand before proceeding to fill up the online form. Please contact hdsmaward.ops21@gmail.com for any clarification.

OPS – Haramoni & Dinabandhu Sahu Memorial Award (OPS-HDSMA)

Nomination Format

Nominator (your) Profile

Salutation (Dr./Mr./Ms./ Prof.)

Name

Email

Phone

Name of your current institution

Address

Nominee Profile

Salutation (Dr./Mr./Ms./Prof.)

Name of the Nominee

Date of Birth (dd/mm/yyyy)

Name of the Institution where the Nominee is working

Address

Skill and accomplishment of the Nominee (max. 500 words)

Recommendation (max. 100 words)

How many years have you known the Nominee? (number only)

In what capacity have you known the Nominee? (max. 100 words)

Are you related to the nominee? (Yes/No)

Declaration

By clicking submit, I certify that all information provided in this Nomination form is true, accurate, and correct to the best of my knowledge.