IEEE Medal for Innovations in Healthcare Technology Nomination Form

Nominator Guidelines

2. Professional Affiliation and Title

3. Business Address (include Email)

4. Home Address

5.Education beyond twelfth grade. Include Institution/location, degree, year received and Honors. Honorary degrees denoted (H.)

6. Endorsers, Names and Addresses, 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.)

7. Proposed Citation. (No more than 25 words.)

8. Principal Employment: Year; Name of Company; Title; Brief, Concise Description of Responsibility.

9. Principal publications and/or patents pertinent to the achievement. (Prefer items of sole responsibility, otherwise give joint names.)

10. Achievements pertinent to the qualifications for the IEEE Medal for Innovations in Healthcare Technology (Criteria considered by the Evaluation Committee shall include: impact on the profession and/or society; succession of significant technical other contributions; leadership in accomplishing worthwhile goal(s); previous honors; and other achievements as evidenced by publications or patents or other evidence.) The quality of the nomination is also considered. (Do not exceed 1200 words.)

11. Principal IEEE Activities; Dates, Description.

12. Other Principal Professional Activities; Dates, Description.

13. Principal Honors (non-IEEE)

14. IEEE Honors/Awards

15. Nominator's Name; Business Affiliation & Address (or home address, if preferred); Telephone; Fax; Email.

15a. How long have you known the candidate, and in what capacity.

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.

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