Nomination Form for JSAP Fellow Award

Nomination Form for JSAP Fellow Award (JSAP Fellow) 1. Nominator Date: Name Signature

Date of birth JSAP membership number I am □ JSAP Honorary member □ JSAP Emeritus member □ JSAP fellow □ Regular Member of JSAP for more than 10 years

Place of Position employment E-mail address

2. Nominee Name

Date of birth JSAP membership number Place of Position Employment Address □ Office □ Home

E-mail address or TEL Notes for nomination (1) Board members, honorary members, and emeritus members of JSAP at the time of nomination and at the time of the Board’s decision are ineligible to be Fellow Award nominee. (2) The nomination form is effective for one year. If your nominee is not selected for the award and you wish to nominate the same member for the following year, please resubmit a new nomination form with updated information. (3) Please fill in the appropriate items on the form. The size of each section can be changed if necessary, but please do not add extra pages. (4) After filling out the form, please e-mail or mail it to the JSAP Fellow Award Candidate Selection Committee. (5) The evaluation form is such an important document in the selection of nominees that we recommend all of the two co-evaluators (evaluators) to submit an evaluation form.

3. Selection of co-evaluators (evaluators) of nominee: two (2) persons

Note: Please select at least one evaluator from an institution different from that of the nominee. Evaluators need not to be members of JSAP.

1 Name

Place of Position employment Address □Office □ Home

E-mail address or TEL

Place of Position employment Address □Office □ Home

E-mail address or TEL Please make sure to provide us with an e-mail address because the evaluation form will be sent to the evaluators by e-mail.

2 4. Biography of nominee Name of nominee Date of birth JSAP membership number Place of Position employment Educational (example: Graduated from the faculty of ___ University in ___(year)) background

Career Please start from the current occupation going chronologically backward through the nominee’s employment history. Briefly describe the position and work content for each employment. If the nominee has worked in one organization for a long time, the description should be focused on his/her most important job or the work experience related to the Fellow Award. (Example: Place of employment, from___(year) to___(year), job title, work in charge, etc.)

The size of each section can be changed if necessary.

3 5. Title most accurately describing the achievements of nominee Title (up to 20 words)

Note: Please give a title of up to 20 words to the achievements of the nominee in a precise and straightforward manner.

6. Achievements of Fellow Award nominee in the field of applied physics Field of □ Academic and research activities □ Industrial contribution achievements □ Education and public-interest activities *Please check the appropriate box. Details of (Focusing on the selected field of achievements, please describe the personal achievements of the achievements nominee concretely and clearly from the viewpoint of the contribution to the progress in applied physics. Up to half a page can be added to this section if necessary.)

4 7. Examples to demonstrate achievements described above Please provide information on the activities of the nominee, focusing on the field that best describes the nominee’s achievements among the three fields listed below. You can also add some helpful information on the nominee’s achievements in other fields. The size of each section can be changed, if necessary, to up to three pages including this page.

Academic and research activities Scientific (Provide a one-line summary, the name of coauthors (underline the candidate), the title, the name papers of the journal, the volume number, and the first and last page numbers (and year of publication)) (Up to 10 papers)

Number Number of Number of of papers articles published published published in papers in OYO APEX/JJA BUTURI P

Industrial contribution Patented or (Provide a one-line summary, the patent number, the patent registration date and the name of commercialize coinventors. Indicate the commercialized technologies among these cases.) d Technologies (Up to 10 papers)

Number Number Number of of patent of articles registrati lectures published in on at JSAP OYO Mtgs. BUTURI

Educational and public-interest activities Details of educational & public-interest activities

5 Number Number of articles of published in OYO lectures BUTURI at JSAP Mtgs. 8. Other information on activities in JSAP Awards won in JSAP

Activities (Position, activities in committees, chapters, and divisions) related to operation of JSAP