Registration for Mid-Career Category (the applicant must be 45 years and below at the time of the close of the application period) – ASEAN-US Science Prize for Women Supported by UL

Upload CV file before fill in the form below, in PDF/Word with format file name: “Name_Country_CV.pdf” or “Name_Country.CV.docx”

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Applicant Background Information
* Mandatory / must be filled
First Name*

Last Name*

Email Address*

Place/Date of Birth*

Phone Number (please include your country code)

Address*

Country(ies) where you hold citizenship*

Education & Employment
Name of university where you obtained your doctoral degree*

Area of expertise/study*

Current employer*

Current title*

Briefly explain your current position*

Please list any professional associations/affiliations of which you are a part

Other
How did you hear about the prize?*

Scientific Excellence
What is your research title?*

Describe you research, technology or business model and how it relates to the 2021 prize topic of Clean Water and Clean Air. Areas of impact could include but not limited to the following: *
• Promotion of activities related to environment, clean water, clean air, etc. such as to prevent environmental damage, minimize the source of wastewater and air pollution, maintain a healthy environment, etc.
• Creation of best available environmental methods or techniques such as for protecting the environment and making the environment sustainable
• Creation of an impact of improving environmental quality particularly by creating clean water and clean air

Describe any awards, merits, or official recognition you've received throughout your scientific career. If none, please insert N/A.*

Has your work been featured in the media, academic journals, policy briefs, or any other substantial publications? If yes, please share three of the notable or unique pieces in which you’ve been featured, and in a few sentences, explain why you selected these three*

In one paragraph, please share how you wish to grow as a scientist.*

Mentoring, inspiring, and supporting women and up-and-coming female members of the STEM. community
Explain how you mentor, support and/or empower female students, colleagues or other women in STEM. Please provide specific examples.*

Describe how your technology, business practice, or research account for gender participation. Does your work specifically target female stakeholders or integrate gender inclusive practices?*

Share what you are doing to improve opportunities for women in STEM. If you belong to organizations focused on this goal, please share details about the organization and your unique role/contribution.*

Global Citizen
Explain how your work, leverages on the use of science, technology and innovation; help to close development gaps throughout the ASEAN region and beyond.*