1. Name and contact information for nominee:
2. Years at NBS/NIST: 19xx -
3. Citation (nominee's claim to honor in twenty-five or fewer words):
4. Birthdate:
5. Education (post secondary):
6. Positions held at NBS/NIST, with dates:
7. Outstanding work at NBS/NIST, including scientific, technical, managerial or administrative contributions, and its impacts:
8. Total numbers of publications and patents based on work at NBS/NIST (list, at most, six significant publications):
9. Important external professional society and committee memberships and work, while employed at NBS/NIST (also, describe the impacts of this external work):
10. Recognitions, awards and distinctions, within and external to NBS/NIST, as a consequence of work while at NBS/NIST:
11. Names and contact information for the nominator and for two current or former NBS/NIST staff willing to support the nomination:
December 2004