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

Senior Member Reference Form

* required field

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

Candidate's Name:

Candidate's Member Number (if known):

Do you know the candidate professionally?
Yes
No

If yes, how many years have you known the candidate?
years

What is your professional relationship to the candidate?

If no, how did you become familiar with the professional background of the candidate?

Has the candidate been in active professional practice for at least 10 years?
Yes
No

How many years has the candidate been in active professional practice?
years

In your own words, explain how the candidate has significantly performed his/her professional duties for at least five years, providing dates will help the review panelists. (See Examples of Significant Performance). (Use as much space as you need)

Please indicate whether you consider the candidate to be:
Well Qualified
Qualified
Marginally Qualified
Not Qualified

Information about the IEEE Member serving as reference

Reference Name:

Reference IEEE Membership Number: *

Reference IEEE Membership Grade:

top of page