VDGOOD Professional Association

(Regd. Organization of the Indian Trust Act, 2013)

Mob: +91 9790546738 | Web :www.vdgood.org, Email : isam21awards@gmail.com
Reg no: U22190TN2019NPL127500

Application Form for VDGOOD International Scientist Awards on Engineering, Science and Medicine
ISAM 2021
(16 & 17- Jul-2021, Mysore, India)

Section - I

Name of the Applicant

Paste
Gender

Date of Birth Age Your

Place of Birth Photo

Nationality Citizenship

Email Id

Mobile Number

Years of Experience Research : Industry : Teaching :

Address

Section - II Present Employment

Note: (These details will be mentioned in shield and certificate,
Carefully fill the form, after if you sent any correction, we can’t change)

Designation

Name of the Department / Division

Date of Joining in the Organization

Name & Address of the Organization

Major Area of Research

Research Interests

Current Research Focus

Official / Personal Webpage or Link

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 Section – III (Academics)

Degree Specialization Name of the University Period

Section – IV (Latest two Research / Constancy Projects Completed)

Title Funding Agency Amount Duration

Section – V (Latest two Patents Granted)

Title Inventor(s) Patent No. Date

Section - VI (Doctoral Degree details)

Department Laboratory

Name of PhD Supervisor

Title of PhD Thesis

Year of Completion of PhD

Section – VII (Mention total numbers only)

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Criteria Status No’s Criteria Status No’s
Granted Papers Presented in International
Patents
Under Process Conferences National
Scientific
Completed
Research Grants Meetings
Invited Presentations
Sanctioned Workshops
Delivered
Completed Conferences
Consultancy Projects
Sanctioned Seminars
Published Graduated
SCI / SSCI Indexed Articles PhD Students Supervised
Accepted Current
Published Books Authored with Books
SCOPUS Indexed Articles
Accepted ISBN Book Chapters
Published International
Other Indexed Articles Professional Membership
Accepted National
For Study Editor in Chief
Countries Visited
For Presentation Editorial Appointments in Associate Editor
International Journals Board Member
Awards Received
National Reviewer

Section – VIII (Please do not exceed 400 words per question)

About Yourself:

Section – IX (Self Declaration)

I confirm that to the best of my knowledge, the information given in this form is correct and complete. At any time I am
found to have concealed / distorted any material information, my application shall be liable to be summarily terminated
without notice / compensation. I have read the terms and conditions and other policies of the VDGOOD International
Scientist Awards and agree to abide the same. I agree to VDGOOD Professional Association to process the data submitted in
this application form, or any other data that the Organization may obtain from me for any purposes connected with ISAM or
for any other legitimate reason.

Date : Place : Scanned Signature of Applicant

 The filled applications along with duly completed curriculum vitae ( of any format), Pass port size photograph, Scan copy
of the PhD Certificate & Scan copy of the Work place ID should be sent via email to : isam21awards@gmail.com

VDGOOD International Scientist Awards - ISAM 2021 Page 3

 For Office Use Only

Note: All decisions by the Organization are taken in good faith on the basis of the statements made on the application form.
If the Organization discovers a false statement or omitted significant information on the application form, it may withdraw or
amend its offer, or terminate the registration, according to the circumstances. The information given on this application form
will be electronically stored and used for administrative purposes by the Organization accordance with the norms of the
ISAM.

Application received date Nomination

Code
Area of Specialization Sub Division
Award Category Eligible as per ISAM
Norms

Recommendations of the Award Committee

Approved 
Rejected 
The reason for rejection is :

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Signature Date

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Signature Date

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Signature Date

Notes:

 The VDGOOD International Scientist Awards - ISAM 'Celebrating the Creative Minds of World' by proudly
recognizing 'Expertly Qualified - Highly Cited Research Professionals' in the age group of 24 - 84 years who are
committed to finding solutions to the daunting challenges.

 Scientist Awards are presented yearly during the Annual Research Meet - ARM that is conducted in the month of
June .For each Specialization / Subdivision / Category (Eg. Distinguished Scientist - Engineering / Mechanical), the
expert committee will select 2 Nominees. However the Apex Committee reserve the rights to honor less or more
than 2 nominees in any category who meet standards set by the expert committee.

 VDGOOD International Scientist Awards is a Non - Profit Organization & hasn't received a sponsorship /
donation for the ISAM. So it is an integral duty of the chosen awardees to register for this. The registration includes
High Buffet Lunch & Breaks to the Award Winner. However, it does not cover the travel and accommodation cost
of the participants. Additional charges are applicable accompanying person(s).

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