NOMINATION FORM FOR

IEEE NIKOLA TESLA AWARD

For outstanding contributions to the generation and utilization of electric power. (See Nominator Guidelines for Eligibility Requirements.)

1. Name 2. IEEE Member: Yes No

IEEE Grade, Year 3. Year of Birth IEEE Member #

Email 4. Professional Affiliation and Title 5. Business Address 6. Home Address 7. Education beyond twelfth grade. Honorary degrees denoted (H).

Institution/Location Degree Year Honors 8. Endorsers, Names, Addresses, and Email. Endorsers should be familiar with the nominee's achievements and should state specific achievements that qualify the candidate for this award. Endorsers should also include a statement indicating

how long they have known the candidate and in what capacity. (Minimum of three supporting letters required; maximum of five permitted. No more than five letters will be reviewed by the Committee. Letters may accompany nomination or be submitted

directly to IEEE.)

Do not exceed space provided. Attached pages are not permitted. ypT e no smaller than 10 point.

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9. Proposed Citation. (No more than 25 words.) 10. Principal Employment: Year, Name of Company; Title; Brief, Concise Description of Responsibility. 11. Principal publications and/or patents pertinent to the achievement. (Prefer items of sole responsibility, otherwise give joint names. Do not exceed space provided. Attached pages are not permitted. Type no smaller than 10 point.

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12. Achievements pertinent to the qualifications for the IEEE Nikola Tesla Award. (Criteria considered by the

Evaluation Committee shall include: impact on technology; inventive value; breadth of use; leadership. The quality of the nomination is also considered. “Generation” areas may include: automation, instrumentation, control;

generation planning; alternative forms, e.g., wind, solar, fuel, cells, space power, etc.; conservation; safety and reliability; life cycle cost optimization. “Utilization” areas may include: conservation; bio-medical, e.g., MRI, focused ultra sound, etc.; life quality improvement for the handicapped; manufacturing systems; robotronics; computers, information systems, communications; lighting, e.g., public safety, commercial, entertainment; special effects (movies, TV, etc.); energy storage (batteries, S.C. magnets, pumped hydro); transportation (propulsion, control, navigation). Do not exceed space provided. Attached pages are not permitted. Type no smaller than 10 point. 3

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13. Principal IEEE Activities; Dates, Description. 14. Other Principal Professional Activities; Dates, Description. 15. Principal Honors (non-IEEE) 16. IEEE Honors/Awards 17. Nominator: Name, Business Affiliation and Address (or home address, if preferred); Telephone; Fax; Email. 17a. How long have you known the candidate and in what capacity? 18. Suggested Presentation Location. (Please provide an IEEE-sponsored technical conference or symposium.) NOTE: The IEEE Awards Board reserves the right to consider any nomination for Institute Awards other than the award suggested when, in its judgment, the support and justification may more appropriately apply to other Institute Awards. Date: Signature:

Submit to: IEEE Awards Activities, 445 Hoes Lane, P.O. Box 1331, Piscataway, NJ 08855-1331 Tel:732.562.3844; Fax:732.981.9019; Email:awards@ieee.org

Note: If sending by courier, please use the following address: 445 Hoes Lane, Piscataway, NJ 08854 Do not exceed space provided. Attached pages are not permitted. Type no smaller than 10 point. 4

Revision08/16/2007