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* 1. Nominee Full Name

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* 2. Position/Job Title

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* 3. Firm Name

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* 4. Nominee Contact Number

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* 5. Nominee Email

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* 6. Years of Engineering Industry Experience

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* 7. College/University

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* 8. Major & Degree

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* 9. Year of Graduation

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* 10. Additional Education & Certifications

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* 11. Positions Held Within Firm and short description of Leadership Roles:

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* 12. Professional Accomplishments:

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* 13. Examples of the Nominee Going Above and Beyond Expected Duties:

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* 14. Professional Organizations and Description of Involvement:

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* 15. Honors/Recognitions:

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* 16. How has the Nominee’s involvement with professional organizations benefited the firm?

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* 17. Civic, Philanthropic & Community Service Organizations Involvement with Description of Role(s):

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* 18. Mentoring Involvement within firm, professional organizations, and/or in civic/community organizations with Description of Role(s):

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* 19. Nominator Name

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* 20. Nominator Title

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* 21. Nominator Email

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* 22. Please upload your nominee’s headshot here.

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