IIE Innovations in Curriculum Award Application Form
To submit the application via e-mail, please complete the form and e-mail it as an attachment to
Honors@iienet.org.
Attach any other supporting documentation for the application to the e-mail.
If you can’t submit the nomination via e-mail, complete this form and submit it by mail,
postmarked by Dec. 1. Nominations sent by mail must include a total of eight copies of this
completed form and eight copies of each recommendation. For either method of submission,
do not attach published articles. Mail to:
IIE Honors & Awards
c/o Office of the President
3577 Parkway Lane, Suite 200
Norcross, GA 30092
For questions, call (770) 449-0461, ext. 105.
Applicant Information:
Name:______________________________________________________________
Address:____________________________________________________________
City, State, Zip:_______________________________________________________
Work Phone:_________________________________________________________
Home Phone:_________________________________________________________
Fax Number:_________________________________________________________
E-mail Address:_______________________________________________________
Date of Birth:_________________________________________________________
Current Position:______________________________________________________
Biographical Data:_____________________________________________________
(use a separate sheet if needed)
Nominator Information:
Name:______________________________________________________________
Address:____________________________________________________________
City, State, Zip:_______________________________________________________
Work Phone:_________________________________________________________
Home Phone:_________________________________________________________
Fax Number:_________________________________________________________
E-mail Address:_______________________________________________________
Nominator's Signature:_________________________________________________
Date:_______________________________________________________________