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AISES Ely S. Parker Award Nomination Form

Deadline to submit is July 8

Nominator Information

Full Name *

Email Address *

Phone *

Connection to Nominee *

Nominee Information

Full Name *

Email Address *

Phone *

Tribal/Indigenous Affiliation (if any)

Company or Organization/Community *

Title, if applicable *

Principal Job Function *0 / 50

Discipline/Field of Work *

Educational Credential(s) *0 / 250

Years of Professional Experience *

Attachments

Cover Letter *

No file chosen

Recent high-resolution photograph/headshot *

No file chosen

2 Letters of Recommendation *

Drag and Drop (or) Choose Files

Information supporting the nominee, including, but not limited to: resume/curriculum vitae; detailed description of the qualifications for the award; job description(s); papers by or about the nominee; organization personnel chart; professional affiliations *

Drag and Drop (or) Choose Files

Material highlighting involvement in the Indigenous community *

Drag and Drop (or) Choose Files

I certify that this nomination and supporting documentation is true and accurate to the best of my knowledge.

Advancing Indigenous Science and Engineering Society

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