2016 DALLAS YOUNG ENGINEER OF THE YEAR AWARD Presented By The DALLAS CHAPTER - TEXAS SOCIETY OF PROFESSIONAL ENGINEERS This award recognizes young engineers who have made outstanding contributions to the engineering profession and their communities during the early years of their careers. NOMINATION FORM Name of Nominee: __________________________________________________Date of Birth___________________ Company Name: _________________________________________________________________________________ Company Address: _______________________________________________________________________________ Company Phone No. : _______________________ FAX No. ____________________ E-Mail: __________________ Home Address: _______________________________________________________Phone No.:__________________ P.E. License Number and State: ______________________________________or, E.I.T. (State) ________________ Nominator: ____________________________ Phone No. (w)______________________E-mail:_________________ Eligibility - Minimum Requirements: 1. Age - 34 or younger as of January 1, 2016. 2. Licensed PE or E.I.T.; graduate of an ABET accredited engineering school 3. NSPE/TSPE member in good standing. The TSPE Awards Committee makes the selection of the recipient based on the following Evaluation Criteria: A. Educational and Collegiate Achievements 12% Include undergraduate and advanced degrees (give date, major, and institution for each), honorary societies (give society and office held), scholastic awards, organizations (give name of organization and office held), and other activities B. Society of Professional Engineers Activities 15% (National, State and Chapter levels of TSPE): List offices held, committee assignments, and awards at each level C. Technical Society Activities 12% (ASCE, ASME, IEEE, AIChE, SPE, etc.) List offices held and committee assignments D. Civic and Humanitarian Activities 12% List offices held and committee assignments E. Continuing Competence 12% List graduate studies (give course and date), short courses and seminars, and papers published (give article, journal and date) F. Engineering Achievements 25% Include current position (title, company, or institution), responsibilities (number of subordinates, annual budget), accountability (position, function, nature of challenge), patents applied for, and awards G. Professional Experience 12% Include dates of employment, employer/location, description of duties Total 100% Nomination Format and Submission Procedure: Nominations must be made using this form. The form should be typed, and all supporting biographical information should be provided and coded by the section number and title it supports, as outlined in the form. The information should appear on a separate page for each lettered section. The nomination form should be submitted electronically. Upon selection, the Award Recipient must submit a digital headshot (head and shoulders) with a minimum resolution of 300 dpi. The Award Recipient should plan to participate in a photo shoot funded by TSPE for the headshot. Deadline: Nominations are due at the email address below by Friday, December 4th, 2015. Jack M. Young, PE, CFM, - TSPE EOY/YEOY 2016 Awards Chair JYoung@Halff.com Page 1 PERSONAL DATA: Candidate Name: ___________________ Date of Application: __________________ Birth Date: Month: _________ Day: ____________ Year: ____________ NSPE Affiliation: Chapter: ___________________________ State: ____________ NSPE Member Number: ___________________________________________________ Candidate’s Home Address: Street: _________________________________________ City: ________________________ State: ____________ Zip Code: ____________________ Candidate’s Daytime Phone: Area Code: _______ Number: _____--__________ Licensure: Classification: _____________________ State: ____ License Number: ____________ Classification: _____________________ State: ____ License Number: ____________ Classification: _____________________ State: ____ License Number: ____________ Page 2 A. Education and Collegiate Achievements: Include undergraduate and advanced degrees (give date, major, institution, and GPA for each), honorary societies (give society and office held), scholastic awards, organization (give name of organization and office held), and other activities. Degrees: Date: ____ Major: _________ Institution: _____________________ GPA: ____ Date: ____ Major: _________ Institution: _____________________ GPA: ____ Date: ____ Major: _________ Institution: _____________________ GPA: ____ Honorary Societies: Society: ___________________________________ Office Held: ______________ Society: ___________________________________ Office Held: ______________ Society: ___________________________________ Office Held: ______________ Scholastic Awards: Award: ______________________________________________________________ Award: ______________________________________________________________ Award: ______________________________________________________________ Organizations: Name of Organization: ________________________ Office Held: _____________ Name of Organization: ________________________ Office Held: _____________ Name of Organization: ________________________ Office Held: _____________ Other Activities: ______________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Page 3 B. Professional Society Activities (national, state and chapter levels): List offices held, committee assignments, and awards at each level. National Office Held: __________________________________________________ National Office Held: __________________________________________________ National Office Held: __________________________________________________ State Office Held: _____________________________________________________ State Office Held: _____________________________________________________ State Office Held: _____________________________________________________ Chapter Office Held: ___________________________________________________ Chapter Office Held: ___________________________________________________ Chapter Office Held: ___________________________________________________ National Committee Assignment: _________________________________________ National Committee Assignment: _________________________________________ National Committee Assignment: _________________________________________ State Committee Assignment: ____________________________________________ State Committee Assignment: ____________________________________________ State Committee Assignment: ____________________________________________ Chapter Committee Assignment: _________________________________________ Chapter Committee Assignment: _________________________________________ Chapter Committee Assignment: _________________________________________ National Award: ______________________________________________________ State Award: _________________________________________________________ Chapter Award: _______________________________________________________ Page 4 C. Technical Society Activities: List offices held and committee assignments. Society: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Society: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Society: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Page 5 D. Civic and Humanitarian Activities: List office held and committee assignments. Activity: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Activity: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Activity: _____________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Office Held: _________________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Committee Assignment: ________________________________________________ Page 6 E. Continuing Competence: List graduate studies (give course and date), short courses and seminars, and papers published (give article, journal, and date). Graduate Studies: Institution: ___________________________________________________________ Course: ____________________________________________ Date: ___________ Institution: ___________________________________________________________ Course: ____________________________________________ Date: ___________ Institution: ___________________________________________________________ Course: ____________________________________________ Date: ___________ Institution: ___________________________________________________________ Course: ____________________________________________ Date: ___________ Short Courses and Seminars: Course or Seminar: ___________________________________ Date: ___________ Course or Seminar: ___________________________________ Date: ___________ Course or Seminar: ___________________________________ Date: ___________ Course or Seminar: ___________________________________ Date: ___________ Papers Published: Article: _____________________________________________________________ Journal: _____________________________________________ Date: __________ Article: _____________________________________________________________ Journal: _____________________________________________ Date: __________ Article: _____________________________________________________________ Journal: _____________________________________________ Date: __________ Page 7 F. Engineering Achievements: Include current position (title, company or institution), responsibilities (number of subordinates, annual budget), accountability (position, function, nature of challenge), patents applied for and awards. Current Position: Title: ____________________________ Company: _________________________ Responsibilities: ______________________________________________________ _____________________________________________________________________ Accountability: _______________________________________________________ _____________________________________________________________________ Engineering Achievement: ______________________________________________ _____________________________________________________________________ Engineering Achievement: ______________________________________________ ____________________________________________________________________ Engineering Achievement: ______________________________________________ ____________________________________________________________________ Engineering Achievement: ______________________________________________ ____________________________________________________________________ Patents Applied For: ___________________________________________________ Patents Applied For: ___________________________________________________ Patents Applied For: ___________________________________________________ Award: ______________________________________________________________ Award: ______________________________________________________________ Award: ______________________________________________________________ Page 8 G. Professional Experience: Include dates of employment, employer/location, description of duties. Employer: ___________________________________________________________ Location: ____________________________________________________________ Employed From Date: _________________ Employed To Date: _______________ Description of Duties: __________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Employer: ___________________________________________________________ Location: ____________________________________________________________ Employed From Date: _________________ Employed To Date: _______________ Description of Duties: __________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Employer: ___________________________________________________________ Location: ____________________________________________________________ Employed From Date: _________________ Employed To Date: _______________ Description of Duties: __________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Page 9