KUWAIT PRIZE NOMINATION FORM

Declaration and Affidavit

I Click here to enter text. declare and acknowledge of the originality of my nominated scientific
research outcomes and take the full responsibilities in case of breaching this commitment.

(A)

Background Data :

(1)

Field of Award

(2)

Name of Nominee

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(3)

Year and Place of

Birth :

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(4)

Present
Nationality :

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enter text.

Proof of Arab Origin :

(6)

Address :

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(7)

E-mail Address :

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(8)

Telephone
Numbers :

1- Work Click here to enter text.

(5)

Choose an item.

Valid Passport
Birth Certificate in an Arabic country

2- Fax: Click here to enter text.

3- Mobile:Click here to enter text.
4- Home:Click here to enter text.

Note : KFAS requires that winners of Kuwait Prize present proof of their Arabic origin either an
Arabic birth certificate or a valid Arabic passport to visit Kuwait and attend the Prize
ceremony.
(1)

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Qualifications (Bachelor-Master-PhD):
Field

Year

Instituti
on

Degree

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text.

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(2)

(10) Academic Honors, Grants and Awards (Prize Name

-Grantor- Year)

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(3)

(11)
Academic and Administrative experience starting with current
position :

Job Title

Organization/Company Name

From

To

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(4)

(B) Scientific Production:

Journal Publications and books Published during the past 20 years
Section (1)
Publications in refereed journals (For papers that are accepted for publications and have not
been published yet, please attach the acceptance letter).
Please list the publications with the name of the author(s), title, journal, and year of publication.
When attaching the publications number them so that they match the list.

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(5)

(B) Scientific Production:

Section (2)
Books: Please list the book with the name of authors, editors, translators, the title, the year
of publication, and the publisher. When attaching the books number them so that they match
the list.

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(6)

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