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Academy Award Nomination

Submission Form

Thank you for your interest in nominating a distinguished engineer. Please enter below the nominator and nominee information. All form fields are required unless marked in blue.

Please note that a confirmation email will be sent to the nominator email address, therefore, please have a valid email address ready for use.

Nomination Type
Academy of Distinguished Engineers Award (Alumni) Distinguished Engineering Service Award (Non-Alumni)
Nominee Information
First Name:	M.I.
Last Name:
Company Name:
Work Address:
City:
State/Province:	Postal/Zip Code:
Country:
Telephone Number:	Email Address:
Fax Number:
Home Address:
City:
State:	Postal/Zip Code
Country:
Education & Professional Affiliations/Positions
Please Enter Degree Awarded, Educational Institution, Location and Year the Degree was Awarded

Please Enter Name of Company, Position(s), Held, Years Employed

Nominee's Outstanding Contributions for Meriting the Award
Describe the nominee's outstanding managerial, technical and/or professional accomplishments meriting the Award. Concentrate on the nominee's significant contributions in his/her profession. It is rather important to identify the particular attributes that qualify the nominee for this Award. For Academy of Distinguished Engineers nominees, describe the nominee's past achievements or interest in enhancing the strong reputation of the engineering programs at the University of Connecticut.

Evidence of Scholarly Achievements:
Number of Scholarly Archival Publications Number of Patents Other significant contributions reflected in publications, patents, etc.
Provide the following information. Section 1: List three most significant items as evidence of technical accomplishment, such as: technical publications, patents and development of products, applications and/or systems. Section 2: List up to 15 items of significant contributions.

Professional Awards/Recognitions and Society Activities
Technical society membership activities and/or other accomplishments in engineering and public service (boards, committees, consultant work, civic activities, University of Connecticut service activities, important offices held and other contributions to society).

Nominator Information
First Name:	M.I.
Last Name:
Organization Name:
Nominator Address:
Telephone Number:	E-mail Address:
Relationship to Nominee:

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University of Connecticut
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