4. Nomination form for CISE Special Recognition Award

Are you of Indian Origin? *
(Check yes if you or your Parents/Grand Parents from India)

Full Name *

Address *

City *

Postal Code *

Contact Number 1 *

Contact Number 2

Contact Email *

Name of the person filling out the form *

Last Name *

First Name *

Middle Initial

Address *

City *

Postal Code *

Home Phone *

Cell Phone

Email *

Resident of Alberta since: *

Why is this person a deserving candidate for the Special Recognition Award?

Please upload any relevant documents in support of the Award Nomination. (Select Multiple Files) only . pdf file is accepted

I agree with the terms set in the guidelines and I understand Award Committee's decision is final and binding

Nomination form for CISE Special Recognition Award ‐ 2024-25