THE INSTITUTE OF ELECTRICAL AND ELECTRONICS …
NOMINATION FORM FOR
IEEE INTERNET AWARD
For exceptional contributions to the advancement of Internet technology for network architecture, mobility
and/or end-use applications. (See Nominator Guidelines for Eligibility Requirements.)
1. Name
2. IEEE Member: Yes No ___ IEEE Grade, Year IEEE Member #
3. Year of Birth
4. Professional Affiliation and Title
5. Business Address
6. Home Address and Email
7. Education beyond twelfth grade. Honorary degrees denoted (H).
Institution/Location Degree Year Honors
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8. Endorsers, Names, Addresses, and Email. Endorsers should be familiar with the nominee’s achievements and should state specific achievements that qualify the candidate for this award. Endorsers should also include a statement indicating how long they have known the candidate and in what capacity. (Minimum of three supporting letters required; maximum of five permitted. No more than five letters will be reviewed by the Committee. Letters may accompany nomination or be submitted directly to IEEE.)
9. Proposed Citation. (No more than 25 words.)
10. Principal Employment: Year, Name of Company; Title; Brief, Concise Description of Responsibility.
11. Principal publications and/or patents pertinent to the achievement. (Prefer items of sole responsibility, otherwise give joint names.)
12. Achievements pertinent to the qualifications for the IEEE Internet Award. (Criteria considered by the Evaluation Committee shall include: innovation, leadership in the field, contributions to open system specification, honors, other achievements. The quality of the nomination is also considered.)
(This section should be written in paragraph form and should not exceed one page in length.)
13. Principal IEEE Activities; Dates, Description.
14. Other Principal Professional Activities; Dates, Description.
15. Principal Honors (non-IEEE)
16. IEEE Honors/Awards
17. Nominator: Name, Business Affiliation and Address (or home address, if preferred); Telephone; Fax; Email.
17a. How long have you known the candidate and in what capacity?
18. Suggested Presentation Location. (Please provide an IEEE-sponsored technical conference or symposium.)
NOTE: The IEEE Awards Board reserves the right to consider any nomination for Institute Awards other than the award suggested when, in its judgment, the support and justification may more appropriately apply to other Institute Awards.
Date: Signature: _____________________
Submit to: IEEE Awards Activities, 445 Hoes Lane, Piscataway, NJ 08854
Tel:732.562.3844; Fax:732.981.9019; Email:awards@
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