Senior Member Application Form

New applicants applying directly for Senior Member grade should submit this elevation form along with an IEEE Member application and your dues payment.

Refer to checklist and deadlines to better understand the application process.
Three reference forms from current IEEE Senior Members or Fellows have to be submitted to support the application unless the applicant has been nominated by a Senior Member or Fellow in which case only two other references are required (See Nomination Information below).
Application and reference forms must be received at the IEEE Operations Center 10 days before an A&A Panel Meeting for processing. Forms received after this deadline cannot be guaranteed to be included in the next scheduled panel meeting.
To verify that your application has been received and for any questions relating to the Senior Member application, please e-mail senior-member@ieee.org OR you may check the status of your application and any reference forms received at Status of SM Applications.
Printable versions of the application form are also available:
- Senior Member Application - Word Format (99 KB, DOC)
- Senior Member Application - PDF Format (36 KB, PDF)

Contact Information

*required field
*First Name:
Middle Name or Initial:
*Last Name or Surname:
*Member # :
Mailing Address:
City:
Province/State:
Postal Code:
Country:
Home Phone:
Home Fax:
E-mail:

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Education

First Professional Degree
School:
City:
Start Date:
Major Course:
Degree Received:
Date Graduated:
Masters
School:
City:
Start Date:
Major Course:
Degree Received:
Date Graduated:
Doctorate/Ph.D.
School:
City:
Start Date:
Major Course:
Degree Received:
Date Graduated:
Present Occupation
Title or Position:
Company Name:
Address:
City:
State:
Country:
Postal Code:
Business Phone:
Business Fax:

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Nomination Information

To qualify for the Nominate A Senior Member Initiative, the following fields have to be filled in completely including the entity to be credited for the nomination. If the nominator is a Senior Member or Fellow, this serves as one reference and the nominator does not need to complete a reference form. It is, however, to the benefit of the applicant if a reference form is received from the nominator as well. A nominating entity MUST BE a SECTION or SOCIETY AND NOT a Chapter or Council. If a Chapter is entered as the nominating entity, the Section to which the Chapter belongs will be given the credit. A nomination can also be submitted without identifying a nominating entity
Nominator's Name:
Nominator's Member #:
Nominating Section or Society:
Nominator's Membership Grade:
Nominator's E-mail:

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Professional Experience

Please list ten years or more of professional experience , which can include up to a maximum of five years for educational experience.
We encourage you to include your resume with your application. You may send your resume to us as an e-mail attachment to senior-member@ieee.org or you may fax your resume to +1 732 562 6528, ATTN: Denise Howard.
Without a resume, there may not be sufficient information for the A&A panel to make a favorable decision which could result in your application being denied or deferred. Please indicate it is for Senior Member Elevation and that you have submitted your elevation form via the web.

(Use as much space as you need)

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Significant Performance

Describe briefly achievements which demonstrate significant performance over a period of at least five years. Normally, significant performance focuses on professional experience during the period following educational experience.

(Use as much space as you need)

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References

Give names and member numbers (if known) of three current Senior Members or Fellows you are submitting as references. You are responsible for contacting these references. Each referee must send a brief note of recommendation directly to IEEE, preferably using the Senior Member Reference Form . If you have difficulty in locating Senior Members or Fellows to serve as the required references, please contact the Section or Chapter Chair for assistance in finding qualified references. For assistance in contacting your Section/Chapter Chair, e-mail Denise Howard at senior-member@ieee.org . While only three references are required, applicants wishing to submit four references may do so. If the applicant is being nominated by a current Senior Member or Fellow, only two references need be submitted. Submittal of a reference form does not by itself constitute a nomination. In order for a nomination to be processed as such, the nomination portion above has to be filled in, with or without a nominating entity. However, if you wish your Section or Society to receive a rebate of $10 for each successful nomination as part of the Nominate a Senior Member Initiative, the Section or Society's name must be provided.
Reference Name1:
Reference Member #::
Reference Name2:
Reference Member #:
Reference Name3:
Reference Member #:
Reference Name4:
Reference Member #:

Alternate Submit Methods

Mail to::	IEEE Admission & Advancement Dept 445 Hoes Lane PO Box 1331 Piscataway, NJ 08855-1331
Fax to:	+1 732 562 6528
E-mail:	Word documents or PDF applications may be sent to senior-member@ieee.org.
E-mail senior-member@ieee.org if you have any questions about your application.

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