NOMINATION FORM FOR THE
NATIONAL POSTDOC PRIZE 2017
IN SCIENCE/MEDICINE
The National Postdoc Prize 2017 is intended for a researcher at a
Dutch university who defended his or her doctoral dissertation in the
specified discipline no more than ten years ago. The deadline for
nominations is 15 July 2017.
Would you like more information?
Visit www.dejongeakademie.nl/postdocprize
INFORMATION ON CANDIDATE
Please attach a brief CV indicating 1) education, 2) public appearances and media activity (including social media), 3) subsidiary activities, and 4)
awards/honours.
Name
Date of birth
Home address
Postal code and town/city
E-mail address
Gender
Male
Female
Institution that awarded PhD
Subject of PhD
Completion date of PhD programme
Discipline
CANDIDATE’S PROFESSIONAL AFFILIATION
Organisation
Job title
Expertise
E-mail address
Web page
RELEVANT PUBLICATIONS
Please submit digital versions of publications issued after the candidate received his/her PhD.
Title of publication
1
2
3
Published in
Publisher
Year of
publication
NOMINATION FORM FOR NATIONAL POSTDOC PRIZE
Page 2 of 2
MOTIVATION
1
Provide brief evidence that the candidate has conducted excellent research that could have a major impact on society.
2
Provide brief evidence of the excellent scientific quality of the postdoctoral research about which the candidate has
published.
3
Provide brief evidence that the research published offers additional insight into and/or contributes to resolving a
societal issue or problem.
4
Provide brief evidence that the candidate disseminates the scientific insights gained from his/her research
throughout society (for example through government, politics or the media, or to the public as a whole).
SIGNATURE
Add your electronic signature (JPG or GIF file)
Signature
Name
Job title
University or institute
E-mail address
Telephone number
SUBMISSION AND ENCLOSURES
Please e-mail this form before 15 July 2017 to:
[email protected]
Required digital enclosures:
– One or more academic publications concerning the candidate’s research,
published after 15 July 2007
– Curriculum vitae of the candidate who performed the research and who is the
subject of the nomination (indicating education; public appearances and media
activity (including social media); subsidiary activities; and awards/honours)
HOW DID YOU HEAR ABOUT THE CALL FOR NOMINATIONS?
You received the call for nominations by e-mail from the DJA/KHMW/Academy
You read about the prize on the DJA/KHMW/Academy website
A colleague alerted you to the prize
Other, namely: