PEI PROFESSIONAL ENGINEER OF THE YEAR AWARD
(Nomination due by October 31)

ASABE: The Society for Engineering in Agricultural, Food and Biological Systems

NOMINATION FORM

PRIVILEGED INFORMATION

This two- to three-page form, along with EITHER supplemental information
OR three (3) nominating statements, will provide the only information used for the evaluation of your candidate. This form must be completed
in 2-3 TYPEWRITTEN PAGES (10 pt. font or larger).
Do Not use Cut and Paste, please type in the information.
This form, along with either supplemental information OR three (3) nominating statements,
will provide the only information used for the evaluation of your candidate.
The form must be complete. PLEASE -- DO NOT USE ALL CAPS IN ENTERING YOUR INFORMATION;
regular punctuation will suffice.

award body
1. Candidate's Name :
first name middle initial last name

2. Primary Employment Position:
2a. Institution/Company:
2b. Telephone number (include area code):

2c. Address:

3. Date of Birth (month, date, year):
3a. Place of Birth, city: state: country:

4. Citizen of (name of country):
4a. If naturalized, give date (month, date, year):

5. Education (list all training and degrees earned, dates, fields, and institutions):
6. Licensed Engineer (list states and number of years):

6a. Professional Engineering Institute (list number of years of membership, not a prerequisite):

7. Area of Specialization:

8. Specific Outstanding Technical and Professional Engineering Accomplishments and Contributions Meriting Selection of the Award (Please limit to 200-300 words):

8a. Supplemental Information: A one-page supplement (500 words or less) MAY BE INCLUDED that provides additional supplemental supporting information concerning Specific Outstanding Technical and Professional Engineering Accomplishments and Contributions Meriting Selection of the Award. The supplemental information could be text further describing the accomplishments of the nominee; OR, nominating statements from no more than three (3) ASABE members who ARE NOT individuals listed as a reference at the bottom of this form.

9. Record of Professional Work Experience (list principal positions and describe primary responsibilities for each; include dates):

10. Contributions of Record (list complete title, including all authors, for only five (5) publications
of most significant impact).
Summary:

Refereed journal articles
Patents
Books
Book chapters
Conference Proceedings
Other publications
Other contributions of record

11. Principal Technical Society Membership (including grades and years of membership) and Activities, and Other Noteworthy Pertinent Accomplishments in Engineering and Public Service (boards, committees, consultantships, important offices held and contributions to society:


12. Professional Recognition (honors, awards, prizes, honorary degrees; give specifics):

13. Proposed Citation (include no more than 20 carefully edited words that reflect specific documented contributions):

Nominated by:
Name:
Affiliation:
Telephone (include area code):
E-Mail Address:

References- List 3-5 reference names; at least two of the references are to be outside the organization submitting the nomination.
1. Name:
Affiliation:
2. Name:
Affiliation:
3. Name:
Affiliation:
4. Name:
Affiliation:
5. Name:
Affiliation: