Annexure

INDIAN INSTITUTION OF INDUSTRIAL ENGINEERING

DR. R. P. MOHANTY GOLD MEDAL FOR

OUTSTANDING TEACHER AWARD

Photo of the
1. Name of the Nominee: ___________ ___________ _____________
Nominee
Surname First Name Middle Name

2. Date of Birth: ___ / ___ / _____

dd mm yyyy

3. Current address of the nominee for Correspondence:

Tel (O) :

Tel (R) :

Mobile :

E-mail :

4. Details of Professional Membership.

5. Details of Teaching Experience:

Sl. Topics / Subjects taught Institution Level (UG/PG/
No. DOCTORAL)
6. List of Research papers published (only 10 best papers in indexed journals)

Journal, Vol., No.,

Sl.
Authors/ Co-authors Title (Month & Year), Pages, Publishers
No.

7. List of significant text/reference books authored along with reviews, if any:

Sl. Title Authors/ Publisher Year of ISBN
No. Co-authors Publication Number
8. List of Research Projects Undertaken
Sl. Name of the Project Sponsoring Agency Name of Co- Amount
No investigator, if any sanctioned

9. List of Doctoral students guided

Sl. Name of the candidate Title of the Thesis Year of
No Completion

10. A brief note highlighting other academic activities in addition to regular duties, such as
general / popular articles / lectures on science / technology / management, organizing
seminars/workshops/training programs/conferences/colloquiums etc. in the subject domains
of industrial engineering discipline, and other outreach activities/social services etc.
11. Any recognition / honor at state/national /international level received by the Nominee for
excellence in teaching/research.

12. A brief write-up by the person endorsing the nomination (not exceeding 500 words) which
in your opinion supports the Nominees eligibility for this award (highlight dedication to
teaching/research, motivational skills, evidence of innovative teaching methods/materials,
functioning as a role model and other qualities you wish to mention).
(To be attached as Appendix A)

The endorsement is based on personal knowledge of the work of the nominee

1. Name

Signature

Address & Seal

Endorsed
by

Full Signature of the Nominee with Date

 Appendix A
Details of Teaching Experience

Sl Topics / Subjects taught Institution Level (UG/PG)

No.