BRICS Young Scientists Forum (BRICS-YSF)

South Africa Conclave, 31 July - 03 August 2023

BRICS Young Scientist Forum 2023
South Africa
31 July 2023 – 03 August 2023

NOMINATION FORM FOR THE 8th

BRICS Young Scientist Forum
INDIA

National Institute of Advanced Studies

Indian Institute of Science (IISc) Campus, Bangalore, India

1
Applicant Photo :
Name : Applicant’s Photo

Designation :
Institute/University/ Affiliation :
Address :
:
:
:
Field of Research :
Date of Birth :
Gender :

Nationality :

Email :
Mobile :
Landline :

Passport Details :
Full Name (as in the passport)
Passport Number
Date of Issue
Date of Expiry

Academic qualification (completed/ expected)

Exam Passed Year of Subjects / Main School / % of marks /

completion specialization College/ Grade
University obtained

10th Class
12th Class
Bachelors
Masters
Ph.D.
Others

Applicants Statement (up to 300 words): Please describe how the applicant has
demonstrated excellence in scientific research, technology and Innovation and how the
achievements could be leveraged among BRICS countries.

2
List of Peer Reviewed Scholarly Publications: Please list the peer reviewed publications
(publication titles should be translated into English). The record of scholarly publication will
be evaluated on its merits, and nominees are encouraged to include publications regardless of
the publisher. Please continue onto separate page if necessary.

Other Awards/ Achievements/ Contributions to market-led innovations: Please list below in English;
please continue onto separate page if necessary.

Details of Application
Primary Theme:
(Choose from one of the following three: Climate change and environmental sustainability; The
future of education, mindset, and skillset; and the future of society)

Additional Documents Required to be attached with the Application form:

• Declaration by the Candidate

• Statement of Purpose
• Resume
• Copy of Passport (First and Last page)
• Reference Letter
• Endorsement letter by the Head of the Organization/ Institute, with official seal/stamp

Place: Signature of the applicant

Date: (Name of the Candidate)