NOMINATION FORM FOR THE
NATIONAL POSTDOC PRIZE
2019
IN SCIENCE/MEDICINE
Would you like more information? Visit www.dejongeakademie.nl/postdocprize
The National Postdoc Prize 2019 is intended for a researcher who defended his or her doctoral dissertation in the specified discipline no more than five years ago.
The deadline for nominations is 15 July 2019.
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
THREE KEY PUBLICATIONS
1Please submit digital versions of publications issued after the candidate received his/her PhD.
Title of publication Published in Publisher Year of publication 1
2 3
NOMINATION FORM FOR NATIONAL POSTDOC PRIZE Page 2 of 2
MOTIVATION
1 Provide brief evidence of the excellent scientific quality of the postdoctoral research about which the candidate has published. Indicate to what extent the candidate works independently and motivate why the three attached publications have been nominated.
2 Provide brief evidence that the research published offers additional insight into and/or contributes to resolving a societal issue or problem.
3 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 2019 to: wetenschapsfondsen@knaw.nl
Required digital enclosures:
–Three academic publications concerning the candidate’s research, published after 1 July 2014
–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:
