Award Application Form

Nomination Form

Award Type*

Nominee information

Please provide formal name as it should appear in recognition materials

Nominee Name*

PrefixFirst NameMiddle NameLast Name

Job Title:

Company Name:*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

Email Address*

Technical Society Affiliation

Number of Year Experience

Nominator Information (provide formal name as it should appear in recognition materia

Nominator Name*

PrefixFirst NameMiddle NameLast Name

Job Title:

Company Name:*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email Address*

Technical Society Affiliation

Engineers' Council awards may be presented at one of the following National Engineers Week Banquet events. Indicate the preferred venue for presentation of this award, if approved by the Honors & Awards Committee.

Presentation Venue*

Los Angeles, CaliforniaWest Palm Beach, FloridaHuntsville, Alabama

Company/Organization Representative

Note: Organizations submitting multiple nominations are strongly encouraged to appoint a single contact with whom the Banquet Chair with communicate to coordinate attendance for all award recipients and guests.

Organization Representative*

Criteria:

Refer to the Engineers' Council home page for award description.

Provide the following information in the respective sections of the following pages.

A. Award Citation. Provide a 30-word citation, suitable for recognition materials.

B. Description of Accomplishments. Describe the candidate's outstanding accomplishments within the last year, and other significant accomplishments within the past 5 years.

C. Contributions to the Profession. Give a brief sketch of present and past technical society positions, activities, affiliations, and offices held.

D. Education.

E. Comments. Please provide any other special reasons for nominating this candidate.

A. Award Citation*

0/30

Examples for the Award Citation:

For distinguished contributions to …

For outstanding achievement and …

In recognition of exceptional contributions to …

(Do not use nominee's name in the citation)

B. Description of Accomplishments*

C. Contributions to the Profession*

D. Education*

E. Comments

Nominations are due December 20, 2024

Photo: Upload a high resolution color digital photograph (minimum 600x800 pixels) of the Nominee with submittal of this nomination form.

Nominations will not be accepted without photograph.

Upload Photo*

Upload a File