Summary Page | Guidelines
This is a web interactive form. This form can also be downloaded in MSWord and .pdf formats.
1 . Name of Candidate: 2. School Address 3. Home Address 4. Phone no. School: 5. Phone no. Home: 6. Email address: 7. Fax:
8. US Resident?
YES NO
9. Citizen: Green Card
Educational Background: 10. High School Graduation Date: 11. Placement in National Examination: out of
12. Colleges Attended: Include Location of college, years attended, graduation date, degree, major/field: 13. Cumulative College Grade Point Average:
14. Comparative EE Class Standing (if unavailable, please enter 'n/a'):
15. College Honors/Other Awards:
16. College Social Organizations:
ADDITIONAL INFORMATION:
17. Work Experience: Include Dates, Employer, Type of Work and Responsibility:
18. IEEE Member: Yes No
18a. If yes, list IEEE activities or other technical societies' activities:
19. Papers presented or prepared:
20. Outline any scientific or technical work you now have in progress:
21. Personal interests, hobbies, recreations:
22. Name of Institution at which you wish to do graduate work:
23. Scholarships or fellowships now held or applied for:
24. Three references - Three college/university professors who are familiar with your work. Include names, addresses, phone, fax and email address:
PERSONAL STATEMENT
25. How do you intend to contribute to the profession of electrical engineering?
