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This award is for (a) exemplary ethical behavior/practices and/or (b) persuasive advocacy or promotion of ethical behaviors/practices by an IEEE member or organizations employing IEEE members.

You can also download this form in MS Word (47KB) or PDF (29KB).

 

Nomination form

1a. Name of Organization Being Nominated

(If nominating an IEEE member, skip this section and go to 1b.)

1a. Organization Being Nominated

Name:

Street Address:

City:
State/Province:

Country:

Zip/Postal Code:

Telephone Number:

E-mail:

To confirm an organization's eligibility for this award indicate at least one or more IEEE members that are employees of the organization.

Last/Family/Surname:

First/Given Name:

Initial:

   
Last/Family/Surname:
First/Given Name:
Initial:
   
Last/Family/Surname:
First/Given Name:
Initial:

1b . Name of IEEE Member Being Nominated

Last/Family/Surname:

First/Given Name:
Initial:
IEEE Member Grade:

IEEE Member Number:

Present Occupation:

Position:

Organization:

Address Type: Business
Home
Street

City
State/Province

Country
Zip/Postal Code

Telephone Number
Email

2. Nominator Information

Last/Family/Surname:

First/Given Name:
Initial:

IEEE Member Grade and Number - IEEE Membership desired, not required.

Member Grade:

Member Number:

Street Address:

City:
State/Province:
Country:
Zip/Postal Code:
Telephone Number:
E-mail:


3. Proposed Citation (not more than 30 words)


4a. Organizational Contributions

1. Describe the major contributions that the organization has made related to (a) exemplary ethical behavior/practices and/or (b) persuasive advocacy of ethical behavior/practices. (not more than 350 words)


2. Explain why the organization's contributions are substantially better than that of the typical organization that employs IEEE Members. Discuss the effects of the contributions on individuals and the organization. (not more than 350 words)


3. Provide additional information that may help the selection committee in its deliberations. (not more than 300 words)


4b. Individual's Contributions

1. Describe the major contributions that the individual has made related to (a) exemplary ethical behavior/practices and/or (b) persuasive advocacy of ethical behavior/practices. (not more than 350 words)


2. Provide additional information that may help the selection committee in its deliberations. (not more than 300 words)


5. Evidence of Accomplishment

List five of the most important items of tangible and verifiable evidence of contribution related to the area of the award. These may be publications, reports, presentation materials, software, or other items. Give accessibility information, including web addresses, but do not submit the actual items. Please give titles in English.  (not more than 400 words)


6. References or Endorsements

List alphabetically the complete names of a minimum of three and maximum of five persons to serve as references. If nominating a company, a majority of the references must come from outside of the nominated company. Members of the IEEE Ethics and Member Conduct Committee and its Awards and Recognition Committee are not eligible to serve in this capacity. IEEE membership is not required for reference writers of this award.

Reference 1

Last/Family/Surname:

First/Given Name:

E-mail:

Reference 2

Last/Family/Surname:

First/Given Name:

E-mail:

Reference 3

Last/Family/Surname:

First/Given Name:

Email:

Reference 4

Last/Family/Surname:

First/Given Name:
E-mail:

Reference 5

Last/Family/Surname:

First/Given Name:

E-mail:
 

 

  

 

 
 

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