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Science & Technology Award (STA)
Particulars of Nominee
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Full Name :
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Malaysian Identity Card No. (NRIC No.) :
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Title:
(eg. Assoc., Prof, Dr, Mr, Ms )
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Age :
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Gender :
--Select--
Male
Female
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Email :
Office:
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Mobile:
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Present Position/Faculty/Department:
Particular of Recommending University/Institution
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Name:
--Select--
HERIOT-WATT
IIUM
IMU
INTI
MAHSA
MARDI
MONASH
NOTTINGHAM
Nuclear Malaysia
QUIP
SIRIM
SUNWAY
TAYLOR
UiTM
UKM
UM
UMK
UMP
UMS
UMT
UniKL
UNIMAP
UNIMAS
UNITEN
UPM
UPSI
USM
UTAR
UTP
Others
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Others:
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Address:
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Name & Designation of Authorised Representative:
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Address of Authorised Representative:
Email:
Office:
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Field(s) of Specialization:
(Max: 25 Words)
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Upload Endorsed Nomination Form:
Rename the file name before upload.
e.g. STA-jamesloo-UM-2025
Particulars of Group Members (Max 4 Members)
None
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*Please check the contents thoroughly before submitting online, as any alteration or re-submission thereafter will be rejected in total.