Malayalee Engineer of the Year Award – Malayalee Engineers Association in North America

EOY Nomination Form

Candidate's Personal Information

Name*

Job title*

Company/Gov’t. Agency or Institution*

Phone*

Fax

Email*

Work Address*

Home Address

MEANA Life Member*

Yes

Nominator Information

Nominator

Title

Address

Phone

Fax

MEANA Life Member

Yes

Professional Registration (if applicable)
Provide your Professional Engineer (P.E.) License Information

State(s)

Registration Number

Date

Registered

Educational and Collegiate Achievements
(Academic degrees: (State date, major, institutions, and identify engineering degrees accredited by ABET.)

File Upload

Upload

Upload File : doc, docx, pdf

Continuing Education during the last 12 months
a. College credit courses, excluding degrees mentioned above: (State course and date.)
b. Short courses and seminars: (State course and date.)
b. Papers published: (State article, journal and date.)

File Upload

Upload

Upload File : doc, docx, pdf

Awards/Honors

File Upload

Upload

Upload File : doc, docx, pdf

Engineering Achievements
Submit a statement of 400 words or less (please submit a separate sheet double-spaced) supporting the candidate's nomination. Facts presented should include engineering achievements in any technical disciplines or management. Please define all acronyms and technical terms.

File Upload

Upload

Upload File : doc, docx, pdf

Professional/Technical Society Activities

List memberships in professional organizations

Offices held and/or committee assignments

Civic and Humanitarian Activities

List name of organization

For publicity purposes, list the names and addresses of two Malayalam publications in nominee's hometown

Captcha