The EMET Prize
Under the Auspices of the Prime-Minister and the A.M.N. Foundation
The EMET Prize Application Form
Category:
Nominee Information
Name of Candidate: (please type the name in English and Hebrew)
Affiliation:
Profession:
Address:
Telephone No.:
Fax No.:
Cell Phone No.:
E-mail Address:
Date of Birth:
Country of Birth:
*Citizenship: ______________________ Place of residence: __________________
Immigration Date:
*The nominee must be a citizen of Israel and reside in Israel for a period of three years prior to the nomination.
Details of Person Submitting Nomination (please type)
Name:
Profession:
Place of Work:
Address:
Telephone No:
Cell Phone No:
E-mail Address:
Date:
Signature:
Instructions
Each topic must be submitted on a separate page.
At the head of each page, list the page number, the topic and the Nominee’s name.
page 1
Reason(s) for Nomination:
page 2
Field of Research,
Nominee in Culture and Arts category, include those works and achievements for which the nomination is submitted.
page 3
Nominee's educational background, degrees, titles and main academic achievements.
_____________________________________________________________________
page 4
Nominee’s professional positions, past and present.
_____________________________________________________________________
page 5
List of publications (include those related to the stated field of research) and/or list of major compositions, artistic, literary, musical or theatrical creations.
page 6
Prizes/Honors previously received (please write the name of the prize/honor, when and where it was granted):
PAGE 7
Resume (Please limit to no more than 250 words.)
Recommendation Letters:
Include a minimum three (3) letters of recommendation from various institutions and professionals in the stated field of research.
Supplemental Material
Any additional material may be provided in addition to (and not in lieu of) the required information requested above. (The supplemental material will not be returned to the sender, please do not send originals).
The forms are to be sent in 4 (four) copies.