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Nominee
Information |
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First Name of Nominee: |
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(required) |
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Middle Name of
Nominee: |
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Last Name of Nominee: |
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(required) |
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Title of Nominee: |
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Organization of Nominee: |
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Address of Nominee: |
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City of Nominee: |
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State/Province of Nominee: |
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Zip/Postal Code of Nominee: |
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(required) |
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Phone of Nominee: |
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(required) |
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E-mail of Nominee: |
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Nominee IEEE Status: |
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(required) |
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Award Information |
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Award Proposed for Nominee: |
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(required) |
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Suggested Citation Wording: |
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(required) |
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Please summarize why the candidate
merits the award. Please include relevant accomplishments,
papers, reports, years of experience, etc: |
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(required) |
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Nominator
Information |
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First Name of Nominator: |
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(required) |
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Middle Name of
Nominator: |
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Last Name of Nominator: |
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(required) |
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Title of Nominator: |
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Organization of Nominator: |
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Address of Nominator: |
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(required) |
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City of Nominator: |
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(required) |
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State/Province of Nominator: |
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(required) |
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Zip/Postal Code of Nominator: |
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(required) |
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Phone of Nominator: |
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(required) |
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E-mail of Nominator: |
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Nominator
IEEE Status: |
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(required) |
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