Official form to be filled out by the Scientific Committee formed to study applications for the disbursement of scientific excellence rewards for scientific publishing. It includes an evaluation of the submitted scientific output in terms of journal quality, impact factors, research originality, and the member's degree of contribution. The committee issues its reasoned recommendation for the disbursement or rejection of the reward or the modification of its value in accordance with the approved controls. This form is the primary document relied upon by the Standing Committee for Scientific Excellence in deciding on reward applications. The Scientific Committee for studying excellence reward applications and the Standing Committee for Scientific Excellence are the target audience.