Volunteer Award Nomination Form

This form should be used to nominate an IEEE member for a United Kingdom and Ireland Section Volunteer Recognition Award.

1. Candidate Information

Candidate Prefix

Candidate Forename *

Candidate Surname *

Candidate Email *

Candidate IEEE Membership No *

Candidate Membership Class *

Candidate Address *

2. Nominator Information

Nominator Prefix

Nominator Forename *

Nominator Surname *

Nominator Email *

Nominator IEEE Membership No *

Nominator Membership Class *

Proposed Citation (max 20 words) *

Case for Support (max 500 words) *

3. Supporters (please list at least three members of the Section supporting this nomination)

3.1 Supporter 1

Supporter 1 Prefix

Supporter 1 Forename *

Supporter 1 Surname *

Supporter 1 Email *

Supporter 1 IEEE Membership No *

Supporter 1 Role in UK&I Section *

3.2 Supporter 2

Supporter 2 Prefix

Supporter 2 Forename *

Supporter 2 Surname *

Supporter 2 Email *

Supporter 2 IEEE Membership No *

Supporter 2 Role in UK&I Section *

3.3 Supporter 3

Supporter 3 Prefix

Supporter 3 Forename *

Supporter 3 Surname *

Supporter 3 Email *

Supporter 3 IEEE Membership No *

Supporter 3 Role in UK&I Section *

3.4 Additional Supporter Details (optional)

Thank you for nominating an IEEE member for a United Kingdom and Ireland Section Volunteer Recognition Award

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