Sir Frank Whittle Medal

Nomination Form

• Download the nomination form (46KB)

• Download the nomination form (967KB)

(*) Indicates required fields

	1. Information on nominee
	Full name*
	Date of birth*
	Address*
	Tel
	Fax
	E-mail
	Appointment*
	Academic qualifications*
	Professional qualifications* giving Institution and grade of membership
	2. Brief citation* (not more than 30 carefully edited words which convey the nominee's outstanding and sustained achievement):
	3. Referees: Letters of support will follow from:
	Referee one*
	Referee two*
	4. Information on nominator
	Name*
	Address*
	Tel
	Fax
	E-mail*
	Extent or personal knowledge of nominee*
	How did you learn of the Medal competition?
	5. Description* in not more than 500 words of outstanding and sustained engineering achievement:
	Please ensure that the nominee’s curriculum vitae and letters of support follow within 2 days of submitting the nomination form. These can be sent either by email or by post.
	Date*
	Signed*
	Before you can submit your request, we need to make sure it is not an automated computer program that's submitting the form. To achieve this, please enter the two words displayed below in the textbox, separated by a space.

Please click only ONCE and wait for the form to be submitted.

Please send the form to:

Sylvia Hampartumian
Assistant Manager, Awards
Secretary, Awards Committee

[E-mail Sylvia]

Tel: 020 7766 0685
Fax: 020 7930 1549

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Sir Frank Whittle Medal Nomination form Rules and conditions