NOMINATION FORM FOR

IEEE CHARLES PROTEUS STEINMETZ AWARD

For exceptional contributions to the development and/or advancement of standards in electrical and electronics engineering. (See Nominator Guidelines for Eligibility Requirements.)

1. Name 2. IEEE Member: Yes No

IEEE Grade, Year 3. Year of Birth IEEE Member #

Email 4. Professional Affiliation and Title 5. Business Address 6. Home Address 7. Education beyond twelfth grade. Honorary degrees denoted (H).

Institution/Location Degree Year Honors 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.)

Do not exceed space provided. Attached pages are not permitted. Typ ne o smaller than 10 point.

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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. Do not exceed space provided. Attached pages are not permitted. Type no smaller than 10 p 2 oint. Revision

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12. Achievements pertinent to the qualifications for the IEEE Charles Proteus Steinmetz Award. (Criteria considered by the Evaluation Committee shall include: engineering and administrative accomplishment and responsibilities; publications (books, standards, papers, conference); honors; supporting letters; IEEE activities; other organizations. The quality of the nomination is also considered.)

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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. This award is usually presented at the annual IEEE-Standards Association Awards Ceremony. If another location is desired, please suggest 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, P.O. Box 1331, Piscataway, NJ 08855-1331 Tel:732.562.3844; Fax:732.981.9019; Email:awards@ieee.org

N ote: If sending by courier, please use the following address: 445 Hoes Lane, Piscataway, NJ 08854

Do not exceed space provided. Attached pages are not permitted. Type no smaller than 10 point. 4

Revision08/16/2007