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For additional information on this program, including examples of ‘demonstrated performance,’
please refer to the Guide for ACM Distinguished Member Nominations.
Also please see the checklist.

Nominations and endorsements must be submitted by 31-JUL-2009.

All information will be kept confidential within the Distinguished Member Committee.
 
   Distinguished Member Category
    Please select the appropriate category
 
  Distinguished Educator Distinguished Engineer Distinguished Scientist
 
   Candidate (See below if this is not a self-nomination)
 
  Last (Family Name)
  First (Given Name)
  Middle (optional)
  Certificate Name
Should you be accepted as a Distinguished Member, please indicate how you would like your name to appear on the certificate
  Email
  Phone
  Fax
  Present Occupation
  Organization
  Organization Type
  Date of Birth (mm/dd/yyyy)
  Gender Male  Female  Prefer not to provide
  ACM Member No.
  --or--
  Username
 
   Business Address
 
  Street
  City
  State/Province
  Zip/Postal
  Country
 
   Home Address
    Same as Above
 
  Street
  City
  State/Province
  Zip/Postal
  Country
 
   Summary of Accomplishments (150 characters or less)
 
 
 
   Accomplishments (4,000 characters or less)
 

Since the data contained in the nomination is the Distinguished Member Committee's key source of information on the candidate, it is essential that the qualifications be described thoroughly, concisely and objectively, stating the significance of the candidate's accomplishments to the discipline and to society.
 
 
 
   Education (List Highest Degree First)
 
    Educational Institution Location Year (yyyy) Degree Major Discipline
  1
  2
  3
 
   Education: If necessary, enter information to further explain the Candidate's education. (1,000 characters or less)
 
 
 
   Professional Experience: List current position first.
   If currently employed, enter current year (i.e. 2006.)
 
    Start Year (yyyy) End Year (yyyy) Name of Organization Position Held
  1
  2
  3
 
  Select Technical Area Categories
    Please select all that apply to the Candidate's body of work 		   Candidate's Resume
 
 
 
 
   Nominator (if not a self-nomination)
 
  Last (Family Name)
  First (Given Name)
  Middle (optional)
  Relationship to Nominee
  ACM Member No.
  Email
  Street
  City
  State/Province
  Zip/Postal
  Country
  Phone
  Fax
 
I understand that ACM will investigate and verify the educational and employment data provided in this nomination. I authorize investigation of all statements contained in this nomination. I understand that misrepresentation or omission of facts contained herein will cause the nomination to be rejected.