Request for Your Scientific Publication List

updated: 04.03.2019

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Title

Dr.

Prof.

Identity Card No. תעודת זהות:

Name (Surname, First Name):

Your Name as it Appears in Your Publications:

Please list all name variations for example: Levi David, Levi, D. etc.

Your Email Address:

Phone:

Department:

Hospital:

Information Details for Articles Published in Referred Journals:

1. First Nomination Candidacy

2. Academic Promotion Candidacy – List Publications as of Prior Procedure Dated (please choose year)

Year:

For academic promotion please add year

Remarks:

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