Please fill out all fields below, and press the "SUBMIT NOMINATION" button at the bottom (only once) to submit.
Please do not submit multiple times. Repeated submissions will cause reviewing confusion.
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IEEE Region 6 Nomination for Outstanding Service Award

For Instruction Please Read Here
 

I. INFORMATION OF NOMINEE

1. Full Name
First/given name first, last/family name last, no comma.
2. E-mail Address
3. Member Information
Member No.
Year Joined IEEE YYYY
Member Grade M (Member) / LM (Life Member) / SM (Senior Member) / F (Fellow)
Year Awarded Current Grade YYYY
Year Since Resident of Region 6 YYYY
4. Affiliation and Title
5. Business Address and Phone
6. Resident Address and Phone
7. Education List Below: Name of Institution, Degree, Year Degree Conferred, Honors
8. Endorsements Two Required: Name, Address, Office Phone, Home Phone
9. Citations (Suggested)
 

II. INFORMATION OF NOMINATOR

1. Full Name
First/given name first, last/family name last, no comma.
2. E-mail Address
3. Member No.
4. Member Grade M (Member) / LM (Life Member) / SM (Senior Member) / F (Fellow)
5. Address and Phone
6. IEEE Position
7. List activities which are pertinent to this award, emphasizing why these accomplishments are worthy of recognition:
8. List services, including dates of offices held:
9. List services to IEEE not already included:
10. Describe the nominee's service to the engineering profession through non-IEEE activities and organizations:
11. Describe the nominee's service to the community and other non-technical organizations: