Senior Member Reference Form

The Review Panel members evaluating Senior Member applications rely heavily on the endorsement and comments provided by references. Please take this into consideration when you complete the following form. It is helpful if you know the applicant personally or professionally, but this is not a strict requirement. You may also request that the applicant send you their résumé or a CV on which to base your recommendation.

Review requirements for IEEE Senior Membership.

Submitting this reference form does not by itself constitute a nomination in conjunction with the Nominate a Senior Member Initiative. In order for the Section or Society to qualify for the NSI rebate of $10 per successful nomination, the nomination section of the SM Application Form must be filled in completely including the name of the nominating entity.

Send questions relating to the Senior Member application process to senior-member@ieee.org.

Printable versions of the Senior Member Reference Form are also available:

Senior Member Reference Form - Word Format (99 KB, DOC)
Senior Member Reference Form - PDF Format (23 KB, PDF)

Senior Member Reference Form

To be completed by the IEEE Senior Member or Fellow serving as reference

Name of Applicant:
Applicant's member number (if known):
Do you know the candidate professionally?
If yes, how long? years
What is your professional relationship to the candidate?
Has the candidate been in active professional practice for at least 10 years?
Total years in the profession:
In your own words, explain how the candidate has significantly performed his/her professional duties for at least five years. (See Examples of Significant Performance). (Use as much space as you need)

Please indicate whether you consider the candidate to be:

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Information about the IEEE Member serving as reference

* denotes required fields.

My Name:
*My IEEE Membership Number:
My IEEE Membership Grade:
Date:

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