Nomination Form
Honorary Member Award
To submit the nomination via e-mail, please complete this form and e-mail it as an attachment to
Honors@iienet.org.
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. 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
Questions? Call (770) 449-0461, ext. 105.
Nominee information
Name:
Address:
City, State, ZIP:
Work phone:
Home phone:
Fax number:
E-mail:
Date of birth:
Current position:
Required data

Identify and describe the specific achievements for which the award is recommended. It is
important that the achievements are considered to be significant and worthy of recognition by
IIE.

Describe how the nominee’s leadership, scientific contribution, statesmanship, or promotion
of awareness led to his or her achievements.

Describe the specific value of the achievements and who received such benefits.
Nominator information
Note: Members of the IIE Board of Trustees, the Honors Steering Committee, those involved in
processing (such as the Director of Honors) or any headquarters staff member may not be used
as a nominator.
Name:
Address:
City, State, ZIP:
Work phone:
Home phone:
Fax number:
E-mail: