Sitaram Jaipuria Foundation Medical & Healthcare Excellence Awards
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Participation
RM_Stats
Email
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Full Name
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Application Type
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Self-Application
Nomination
Salutation
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Prof.
Dr.
Gender
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Male
Female
Others
Educational qualification
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MBBS
MD
MS
DNB
DM
MCH
Medical council registration number
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Awards Category applied for
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Excellence in Medical & Healthcare
Outstanding Contribution in Covid Care
Emerging Young Leader in Medicine
Exemplary Leadership in Rural Healthcare
Work Address
Address Line 1
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Home Address( present )
Address Line 1
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Phone
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Email
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Total Years of experience
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Current positions
Organization name
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Designation
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Years of affiliation
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Previous work positions
Organization name
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Designation
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Years of affiliation
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Significant Honours/ Awards
H-Index
Write up (about 150 words) on the applicant’s Key Contributions relevant to the category of the award applied along with write up (about 50 words per eligibility criteria/ sub criteria) describing how the applicant meets the criteria. Independently verifiable supporting documents should also be uploaded.
Full list of publications (extracts not required)
Citations of the top publications (not more than 5) most relevant to and supportive of the application/ nomination. A short statement of each publication’s significance, impact factor and the change in practice or policy should also be uploaded.
Letters of support /Recommendation from peer and professional group (Minimum 2 and maximum 8)
Full curriculum vitae
Age Proof
Additional Uploads
a) Analysis of the applicant/nominee standing compared to peer group in the field of work
Letters of recommendation from the general public
Details of the Proposer
Title
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Name
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Address
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Phone
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Email
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f) Comments in support of the nomination (about 100 words)
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Any other information the applicant may wish to submit in support of this application
Verification
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Any other information the applicant may wish to submit in support of this application
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