IPS-10. INDIAN PHARMACOLOGICAL SOCIETY (Registered Under The Society Registration Act XXI of Patna. R. No. 03/ )

Transcription

1 IPS-10 INDIAN PHARMACOLOGICAL SOCIETY (Registered Under The Society Registration Act XXI of Patna. R. No. 03/ ) NOMINATION FORM FOR THE POST OF CHIEF EDITOR (Constitution A) 1. Name in full (Surname Middle - Last ) 2. Date of Birth : 3. Designation : 4. ity* : 5. Address for correspondence District State PIN: Phone: (O) (R) Mobile: Fax: 6. Permanent Address 7. IPS Life Membership Number / of Enrolment: 8. Academic details: PART A S. No. Degree of Acquiring 1. D.Sc. University Distinction 2. Ph.D/D.M 3. MD/MS/MVSc/M. Pharm.,/MDS/M.Sc. 4. Diploma 5. Graduation Academic records 6. Rank/medals/prizes in the university Additional qualification/training : * Indian holder is only eligible 1 / 6

2 9. Professional Experience & Peer Recognition: A. Vice-Chancellor/Director** B. Director C. Principal /Dean/Proctor/Rector or equivalent* D. Professor* / Additional Processor* / Scientist F (Deputy Director) or Equivalent E. Associate Processor/Reader/ UGC Research Scientist B/ Assistant Director of Research Institute/Medical Superintendent F. Assistant Processor/Lecturer /SRO/ UGC Research Scientist A Duration with years Name of the Institution 10. AWARDS AND HONOURS Only awards, honours (Do not list lectures delivered) S. No. Name of Award/Fellowship 11. Membership of the Technical Expert Groups and Consultancy: (provide annexure) 1 Membership of the Technical Expert groups / Advisory groups /Study group / or corresponding groups / Committees of agencies e.g. Planning Commission /Expert Group of Ministry of Health & Family Welfare or WHO, UNICEF or other International agencies 2 Membership in Expert Groups, or of the corresponding Committees of CSIR/DST/DBT/UGC/ others 3 Member of Academic Council / Academic Committee of other decision making academic bodies of Universities / Academies / Institutes of Importance 4 Consultancy with any UN/International organization visiting Professor of a reputed University 5 Who Temporary Adviser (or served in similar capacity with any other equivalent International organization) 2 / 6

3 12. Examiner profile: S.no. Degree (Academic details) Numbers 1 Doctorate 2 DM 3. MD 4. Graduate 12.1 Scientific Projects: (List in Annexure) S.No. Title of Project Investigator Status PI/Co-PI Funding Agency Current Status Completed Ongoing Future 12.2 Publication (Annexure) Pub med 12.3 Patent (The Patent applied for or obtained by the nominee may be considered by the Credentials Committee): (i) The patent is applied for the year : (ii) The patent granted by the agency : (iii) Pending of the final decision: 3 / 6

4 13. Editorial competency: PART - B 13.1 Editor: 13.2 Co- Editor: 13.3 Editorial committee member: 13.4 Books a. Authorship /Editorship of Text Book (s) Monograph (s) Chapters in standard text books /volume of proceedings of Major and Inter- Conferences of recognized professional Societies / Associations 13.5 Affiliations in IPS: (Executive Council) S. No. Affiliations in IPS Regional/ Local 4 / 6

5 Statements of your experience in publications (Maximum of 100 words): 15. How would you like to take the journal further (Maximum of 100 words): 16. Nomination for the post of Chief Editor of IPS* (Pls. check point 10 in Eligibility criteria)instructions to the proposer: 1. Proposer Name: Signature: (in block letters) Recommendation Proposer Name: Signature: (in block letters) Recommendation Declaration I hereby declare that the above information provided by me is true to the best of my knowledge. I abide by the decision of EC of IPS. Signature of Applicant OFFICE USE: Scores PART A (30).. PART B (50) Society service (10)... EC Executive Council (20)... Total. EC decision with recommendations... GB ratifications... Signature of President IPS 5 / 6

6 Eligibility criteria 1. Applicant should have ten years life membership status in Indian Pharmacological Society, and served the society as Executive committee member at least for one term. 2. The Maximum age limit of the applicant is 55 years. 3. The application along with all documents claiming achievements and experience must be self-certified. 4. The applicants must be nominated by two and must be one from eminent pharmacologists who is life members of the IPS. 5. The applicants served for two consecutive terms as Chief Editor is not eligible to submit the application. 6. The application of applicant under suspension, involved in any legal cases, involved in any financial fraud will be rejected by Executive committee. 7. Applicants must submit No Objection Certificate from their respective organisation to take this honorary assignment. 8. The applicant should submit No Conflict of Interest declaration along with application. 9. The applicant should not canvass by any means to get nominated for the post of chief editor. 10. Instructions to the proposer: 10.1 One nomination should be made by Eminent Member of Pharmacological Society of India: 10.2 Any Eminent Academicians/Scientists/ Industrialist 10.3 All entries in the nomination form should be completed. The Nomination not complete in all respects is liable to be rejected. Check List: 1- Copy of I.D. (Official) 2- Copy of Aadhar Card 3- Copy of Income Tax 4- Copy of Pass Port 5- Application with enclosures (no s ) 6 / 6