2017 Technovation Sarabhai Award - Application Form

2017 Technovation Sarabhai Award - Application Form Application Deadline: December 15, 2017

Sarabhai award is for outstanding contributions by an Individual leader to Indian semiconductor or electronics industry.

This award recognizes the industry professional for his/her sustained and outstanding contribution in the field of electronics or semiconductors in India. The contributions from this individual should have helped India to take another step in the area of electronics and semiconductors.

Selection Criteria

 The award is for a distinguished industry professional for his or her outstanding achievements (leadership) in the area of electronics or semiconductors.  The award is for an individual who has stayed in India for several years and for his contributions which has helped India to take a step forward in the area of electronics or semiconductors  Recommendations/Nominations could be done by any employee of any company  Entries would be accepted only on second-party nomination basis. Self-nomination is not allowed.  If, by chance, no nominations are received, members of the IESA Executive Council could nominate visionaries worthy of the award. The same application form should be used for the nominations.

- Please read the instructions at http://www.iesaonline.org/Technovation2017/guidelines.html before filling in the application form. - Please e-mail both the word and pdf document of the fully filled nomination form to [email protected] with the appropriate documents attached. - If you have questions, please email to [email protected]. We will get back to you within 48 hours. - All supporting documents should be attached in PDF format. If you need to attach multiple documents for a particular item, please put all documents into one ZIP file and attach the ZIP file - Fully completed application forms enable the Award Selection panel to do a proper review and increase your chances of getting selected - Please avoid confidential data like schematics, detailed algorithms etc - IESA will confirm the receipt of your nomination form via email within 48 hours. Kindly request you to please get in touch with us in the absence of any confirmation to ensure that your nomination has been successfully delivered and received.

Kindly fill up the nomination for IESA Technovation Sarabhai Award 2017 form below:

Name of the entity:

Name of the Nominating person:

You are currently working with the: (Mark “Y” corresponding to the relevant area): Industry: Academia:

India Electronics & Semiconductor Association 1 www.iesaonline.org Unit G-02, Ground Floor, Prestige Terminus-II, 901 Civil Aviation Road, (Old HAL Airport Exit Road), Konena Agrahara Bangalore 560 017| Phone: +91 80 4147 3251 | Facsimile: +91 80 4122 1866 Others (Please Specify):

Address for correspondence: Postal address: Email: Mobile: Telephone (Office): Telephone (Residence Facsimile:

Nature of your job:

Have you ever been associated with the nominee? (Yes/No)

If yes, describe the nature & duration of your association with the nominee:

NAME OF NOMINEE (Sarabhai Award):

Address for correspondence: Postal address: Email: Mobile: Telephone (Office): Telephone (Residence Facsimile:

Organization / institution working with:

Current affiliation/designation:

Area of research / work:

Is the nominee technically involved with your organization / institution? (Yes/No)

Is the nominee a resident of India? (Yes/No)

India Electronics & Semiconductor Association 2 www.iesaonline.org Unit G-02, Ground Floor, Prestige Terminus-II, 901 Civil Aviation Road, (Old HAL Airport Exit Road), Konena Agrahara Bangalore 560 017| Phone: +91 80 4147 3251 | Facsimile: +91 80 4122 1866 In your opinion, why is he a contender for Sarabhai award (Limit to 300 words)? (Explain the link to India)

Any other information, which in your opinion is relevant to this application:

Please mention the Documents Attached for Reference: ● ● ● ●

India Electronics & Semiconductor Association 3 www.iesaonline.org Unit G-02, Ground Floor, Prestige Terminus-II, 901 Civil Aviation Road, (Old HAL Airport Exit Road), Konena Agrahara Bangalore 560 017| Phone: +91 80 4147 3251 | Facsimile: +91 80 4122 1866