Nominee: Insert Name
ITE Western District
Lifetime Achievement Award
Nominee Information
The Lifetime Achievement Award is the District’s highest honor and recognition of professional accomplishment and service to the District, ITE and the profession of transportation engineering and/or planning. Eligible nominees must be active or retired members of the Western District whose achievements have spanned a period of not less than 20 years. The nomination form shall be limited to three pages, and shall be submitted to the Western District Past President no later than November 1 to be considered in the following year. Each nominee will be judged solely on the information submitted in the form and will be awarded a maximum of 15 points by the judging panel.
Nominee: ______
1) Years of experience: ##
2) Current Professional Position: Text
3) Educational Background
a. Degree, year obtained, institution
b. Degree, year obtained, institution
4) Registrations: Text
Summary of Service to ITE in the Interest of Western District (Maximum of 6 points)
· ITE District/Section/Chapter Affiliations (past and current)
· ITE Positions within the Western District (officer, chair, committee, task force)
· ITE Awards and Recognition
· ITE Publications/Presentations
Summary of Service to the Transportation Profession (Maximum of 6 points)
· Other Associations (Leadership positions, significant involvement, awards)
· Key committees
· Key papers/publications/projects/achievements over the course of their career
· Key awards and recognition by other associations
Narrative Description of Continued Involvement with ITE (Maximum of 3 points)
Expand upon the information provided above as necessary to highlight how this nominee has remained active and engaged with ITE on the District and/or International level. The narrative should focus on the nominee’s activities within the last five (5) years.
Summary (Required)
Expand upon the information provided above as necessary to indicate why this nominee should receive the District’s highest recognition of professional and outstanding service in the interest of the Western District.
Submitted by: ______Date: ______
Western District Lifetime Achievement Award Nomination Form (rev 9/16) Page 2