Once Completed, Attach Reference Forms and Send It Directly To

ISCA

FELLOW GRADE

NOMINATION FORM

The candidate must have been an ISCA member for at least 5 years, and have been active in the field for over 10 years.

Once completed, attach reference forms and send it directly to:

Last (Family) NameFirstMiddlePrefix

Organization’s Name (If None, Please leave blank) Organization's Affiliation (Education/Industry/Government/Other)

Preferred Mailing Address

City State/ProvinceZip/Postal CodeCountry

Telephone #Fax#EmailISCA Member Number

Home Page (where full curriculum vitae can be found)

Year/ Month (of graduation) Name of University, Country Degree

Year/Month (from - to) Name of university/company, Country Position

-

Identify the category in which the candidate has made significant contributions that would qualify him/her for Fellow grade. Check one (or more if it is necessary).

Research Engineer/Scientist Technical Leader Educator Others ( )

5a. Describe your relationship to the candidate and how you, PERSONALLY, became aware of the importance of his/her extraordinary accomplishments and their impact on society (not more than 100 words total).

5b. Explain how the candidate’s one or two most distinctive contributions have contributed to the advancement or application of engineering, science, and technology. Explain how these contributions of unusual distinction have had a lasting impact on society. Identify specific attributes of the candidate’s contributions that qualify him/her for elevation to Fellow, and why the candidate ranks near the top of those in his/her discipline(not more than 750 words total).

Supply the following information in two parts. PART 1: List the three most important items of tangible and verifiable evidence of technical accomplishments identified in section 5b, such as: technical publications; technical reports and presentations; patents; development of products, applications and systems; and, application of facilities and services. In sentence form, state the engineering significance and lasting societal impact of each. PART 2: List not more than 10 additional items, subdivided into distinct areas of contributions. In sentence form, identify the significance and impact of each. List titles of publications in English.

1.

2.

3.

4.

5.

6.

7.

NOTE: If the above nominee is elected to Fellow grade, the nominator agrees to release the contents of this form to authorized ISCA committees for the purpose of recommending candidates for ISCA Fellowships. This nomination form will be released only for this purpose.

Last (Family) Name First MiddlePrefix

Name of Organization

Mailing Address

City State/ProvinceZip/Postal CodeCountry

Telephone # Fax# Email ISCA Member #