Yu-Hsiu Ku Electrical Engineering Award

NOMINATION FORM

Before completing this form please read all the information carefully. Limit copy to the space provided; type size smaller than 10 point will not be accepted

1. NAME OF CANDIDATE:

Last (Family Name) FirstMiddle

Company :______

Occupation:______

Position on Organization

Business address: City /State / ProvinceCountry

Zip /Postal Code

Home Address: City /State / ProvinceCountry

Zip /Postal Code

Preferred Mailing Address:

Telephone:______Fax:______

E-Mail: ______

This nomination is being submitted for award presentation in year: ______

2. EDUCATION, LIMIT COPY TO SPACE PROVIDED; if necessary, cite only most significant.

Educational Institution / Location / Degrees / Year

3. PROFESSIONAL HISTORY. Current position first. LIMIT COPY TO SPACE PROVIDED; if necessary, cite only most recent positions.

From (year) to (year) / Name of Company / Position Held and Responsibilities

4. NOMINATOR

Name______

Nameof Company______

Date:______

Address: ______

Telephone:______Fax:______

E-Mail:______

NOTE: If the above nominee is selected for the Yu-Hsiu Ku Electrical Engineering Award, the nominator agrees to release the contents of this form to the Yu-Hsiu Ku Electrical Engineering Award Committee for the purpose of bestowing the award to the candidate. Only this nomination form will be released.

5. INDIVIDUAL CONTRIBUTIONS. Specify succinctly.

  1. Summarize the candidate’s significant technical accomplishments relating to electricity, electrical machinery, power system engineering and/or related fields.(limited to 100 words)
  1. Describe succinctly the impact of the contributions on electricity, electrical machinery, power system engineering and/or related fields. (limited to 100 words)

Describe the originality or innovative nature of the contributions.(limited to 100 words)

6. EVIDENCE OF TECHNICAL ACCOMPLISHMENT. DO NOT EXCEED THE SPACE PROVIDED ON THIS PAGE; TYPE SIZE SMALLER THAN 10 WILL NOT BE ACCEPTED.

PART 1: List up to three of the most important and verifiable technical accomplishment, such as: technical publications; technical reports and presentations; patents; Development of products, applications and systems; and application of facilities and services. Succinctly state the importance of each.

PART 2: List not more than 10 additional items of technical accomplishment. Where possible, identify their individual importance.

7. ACHIEVEMENTS IN OTHER FIELDS:

8. EVIDENCE OF PROFESSIONAL LEADERSHIP (contributions to professional societies, governmental organizations, etc.)

  1. Yu-Hsiu Ku Electrical Engineering Award REFERENCES.

List alphabetically the complete names. Up to 5 will be accepted. Each reference is required to submit an endorsement letter, which should substantiate the nominee’s qualifications. The letter must be limited to one page. Only the first page of endorsement letters will be accepted – all other pages will be rejected.

1. / Name: / Company：
2. / Name: / Company：
3. / Name: / Company：
4. / Name: / Company：
5. / Name: / Company：

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