NOMINATION FORM FOR THE HOOVER MEDAL

The Hoover Medal recognizes outstanding extra-career services by engineers to humanity.

Nominations are to be received no later than February 15 of the first year in which the nominee is to be considered for the award. Nominations (using only this form and required attachments) should be sent to:

The Secretary, Hoover Medal Board of Award
c/o ASME
Two Park Avenue
New York, NY 10016-5990
E-mail: / Date of submission ______

NOMINEE PERSONAL INFORMATION

FULL NAME OF NOMINEE:
Mailing Address:
Telephone Number(s)/ Other Contacts of Nominee:
Home: / Office:
Cell Phone: / E-mail Address:
2A. Professional Employment & Status of Nominee: (Indicate current position held, or retired or other status)
2B. Professional Society Memberships:
2C. If, and only if 2A or 2B do not clearly establish the engineering background of the nominee, his/her engineering education can be cited here (school, degree, dates):
3A. Civic and Other Societies or Associations and/or awards:
3B/C. CITATION: a 25-30 word summary of nominee’s achievements with “outstanding humanitarian or civic activities,” performed “extra-career,” not as a required function or duty of an engineering career position held. (May be 3B a single most important humanitarian or civic contribution). Or 3B and optionally3C a listor summary (300 word maximum) of achievements.
3B.
3C. (optionally)
4. NOMINATOR/S Information: Name of original nominator and Board Sponsor, along with address/es and Society
Name:
Mailing Address:
Phone: / E-mail:
Society Affiliation:
Name of Hoover Medal Board Sponsor:
5. REFERENCES:Sources of the five attached letters. (Names and addresses of the individuals who prepared the five attached letters of support. Additional letters will be discarded in the order received). Use online Reference Letter Form.
Name #1:
Mailing Address:
Name #2:
Mailing Address:
Name #3:
Mailing Address:
Name #4:
Mailing Address:
Name #5:
Mailing Address:
6. BRIEF BIOGRAPHY: Give date and place of birth, citizenship, education, positions held, honors, participation in engineering societies. Attach any references from Who’s Who, Who’s Who in Engineering and/or American Men and Women of Science.
Biography:
7A. Date of submission: / 7B.Date of receipt by the Board (Secretary will fill in)
[Nominations shall be carried forward and reconsidered by the Board for a period of three (3) consecutive years from the first submission of a fully completed submission including this Application and all accompanying and supporting documentation. Applications may be resubmitted for further consideration of the nominee for another three (3) year period thereafter based on submittal of a newly re-executed application form; other supporting documents do not have to be resubmitted.]

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