Fellow Nomination Reference Forms

If you have been asked to complete a Fellow Reference Form for a nominee, you may use this online reference form or download and mail the form below.

Optical Society of America
Executive Office / Awards
2010 Massachusetts Avenue, N.W.
Washington, D.C. 20036-1023 USA
Fax: 1.202.416.6134
awards@osa.org

This form must be received at OSA by June 15.

PDF Fellow Nomination Reference

Fellow Nomination Reference Form (

PDF, 14 KB)

Note: You need Adobe Acrobat to view the PDF files above. If you do not already have this software, you can download Adobe Acrobat for free from Adobe's web site.

Online Fellow Nomination Reference

Please be aware that your session will time out after 90 minutes and plan accordingly. Unfortunately, your entry will not be saved unless you submit it within 90 minutes.

General Information

*Nominee's Name:
*Nominator's Name:

Referee Information

*First Name:
*Last Name:
OSA Fellow:	YesNo
OSA Member:	YesNo
OSA Member No.:
Company/Institution:
Department/Mailstop:
*Street Address:
*City:
*State/Province:
*Country:
*Postal Code:
Phone:
Fax:
*E-mail Address:

Privileged Information

I have known the nominee professionally for years.
I consider the nominee to be: Select one
	Exceptionally well qualified for Fellow
	Well qualified for Fellow
	Marginally qualified for Fellow
	Not qualified for Fellow
My judgment is based on:
	Personal knowledge of nominee's work
	Review of nominee's record
Please describe your specific knowledge of the nominee's professional and other accomplishments that support election to OSA Fellow. You may write a few lines in the comment box OR (NEW) upload longer comments or a letter. The size of the comment box is limited.

Click on the Browse button and navigate to find the file on your computer. Double click on your file to put the path and filename in the box. Press the Submit button to continue. Note: we accept the following file extenstions: .doc, .txt, .pdf, .zip.

Rate the nominee on the following factors. If a factor is not applicable to the nominee's accomplishments, enter N/A. Contributions to optics: (on a 1 to 5 scale, 5 being very significant, 1 being insignificant)
	By enhancing scientific knowledge
	By applications of technical knowledge
	Through technical management
	Through professional service
	Through teaching

Your on-line submission will be acknowledged by an e-mail message. If that message does not appear within a reasonable period, please contact awards@osa.org to confirm that your nomination was received.