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

Senior Member nominations are accepted throughout the year and are reviewed by the
Senior Member Nominations Committee in cycles. The deadline for the current cycle
is August 31, 2009. [Full Guidelines]

All information will be kept confidential within the Senior Member Committee.
 
   Candidate
 
  Last (Family Name)
  First (Given Name)
  Middle (optional)
  Certificate Name
Should you be accepted as a Senior Member, please indicate how you would like your name to appear on the certificate
  Email
  Phone
  Fax
  Present Occupation
  Organization
  Organization Type
  Birth Date (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
 
   Accomplishments (4,000 characters or less)
 
 
 
   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, please enter the current year as "End Year".)
 
    Start Year (yyyy) End Year (yyyy) Name of Organization Position Held
  1
  2
  3
 
   Summary of Professional Experience (1,500 characters or less)
 
 
 
  Select Technical Area Categories
    Please select all that apply to the Candidate's body of work 		 
 
 
   
 
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.