IEEE-USA Nomination Form

Electronics Packaging (EP) Society Regional Contribution Awards 2018 Nomination Form (Due date: January 22, 2018)

AWARD SUGGESTED: (See description at the end) Check only one box. [ ] Region 8 (Europe) [ ] Region 10 (Asia Pacific) [ ] Regions 1-7 and 9 (Americas)

PROPOSED CANDIDATE: Candidate’sCandidate’s PROPOSED CANDIDATE: PicturePicture here here Name:Name: Position:Position: WorkWork Address: Address:

WorkWork Telephone: Telephone: ( ( ) ) Email:Email: IEEE/EPSIEEE/EPS Membership Membership Years/Status: Years/Status:

The EP Society Awards Recognition Committee reserves the right to consider any nomination for awards other than the award suggested when, in its opinion, the support and justification may more appropriately apply to *ed*ed other EP Society awards.

1. Please state briefly why the nominee deserves of recognition, keeping in mind the purpose of the award and the individual’s accomplishments. Please feel free to mail supporting documents to strengthen your nomination. Endorsement letters should be submitted separately. Self-nominations will not be considered.

Date received by the EP Society Awards Committee (Due date: January 22, 2018): ______

1 Please provide the following information. Please note that the information you provide serves as the basis for the evaluations. The Committee will endeavor to confirm the validity of the information it receives, but it cannot supply or elaborate on statements.

2. What IEEE, EP Society (or other professional societies) responsibilities has the nominee had in the last five years that have been related to professional activities? (Please provide approximate dates.)

3. What specific significant or distinguished contributions or achievements made you decide to submit this nomination?

4. What factors suggest to you that these contributions or achievements are substantially above and beyond those reflecting the good job expected of any occupant of this position(s).

5. Please use this space to provide details concerning the nominee and his or her professional activities, contributions or achievements. Your comments should amplify your brief responses to items 1, 3, & 4. Exhibits may be sent separately. Please note that the evaluations are based upon accomplished and identifiable activities.

2 PleasePlease provide provide a a 20 20 to to 35 35 words words contribution contribution summary summary for for the the award award citation: citation:

NOMINATOR:

Name: IEEE Member Grade: Position: E-mail Address: Work Address:

Telephone: ( )

If others are submitting endorsements to support this nomination, please provide their names and emails. Note: endorsements are to be sent directly to the respective EPS Region Award Coordinator. Endorsements sent from the nominator will not be considered. A minimum of 2 endorsements is recommended.

Endorser name

Name e-mail

3 EP Society offers the EPS Regional Awards for the purpose of recognizing outstanding service and contributions to furthering the professional purposes of IEEE and EP Society on a Regional Level.

 DESCRIPTION: To recognize significant and outstanding leadership and contributions to the growth and impact of EPS programs and activities at the Region level.  Maximum of one award annually from each Regions/Groups of Regions (3 awards):  Regions 1-7 & 9  Region 8  Region 10

 PRIZE: $1000 (equivalent in local currency) and a Certificate for each recipient

 FUNDING: Funded by the Electronics Packaging Society .  ELIGIBILITY: Recipient have been a member of IEEE and EPS for at least the past three (3) years (2015-2017) and renewed for the year of the Award (2018)

 BASIS FOR JUDGING: Demonstrated service and leadership in areas that may include but are not limited to Chapter activities, Conference/Workshop activities, Membership Development, Student Programs and Technical Activities.

 SELECTION: The respective EPS Regional Advisory Committees will receive nominations, evaluate candidates, select a candidate's), and present candidate's) to EP Society Awards Committee for review and approval.

 PRESENTATION: Presented at EPS meeting within Region of the Award (e.g. Region 8 Award – at ESTC; Region 10 Award – at EPTC).

Submit to:

For Regions 1-7,9 Eric Perfecto, Director, Award Programs, [email protected]

For Region 10 Orii Yasumitsu, Region 10 Director, [email protected]

For Region 8 Toni Mantilla, Region 8 Director, [email protected]

For any additional information, please call 845-894-4400

Winners will be notified by 9 April 2017, and the awards will be presented at the 68th Electronic Components and Technology Conference (ECTC), May 29 - June 1, 2018 at the Sheraton San Diego Hotel, San Diego, CA (USA).