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Vice-Chancellor’s Excellence Awards 2016Excellence in University Engagement and SustainabilityNomination Form - StaffSECTION 1 NOMINEE DETAILSINDIVIDUAL

Staff Id Number

Contact Number

Name (incl title)Position/ Title Length of

ServiceSchool / UnitEmail Address

TEAM

Team NameTeam LeaderPosition/ Title School/ UnitTeam Members

1. School/ Unit2. School/ Unit3. School/ Unit4. School/ Unit5. School/ Unit6. School/ Unit

(if insufficient space, please attach a list)SECTION 2 ACCEPTANCE OF NOMINATION BY NOMINEE

I/We hereby give permission for the Western Sydney University, to use my/our photograph/s in official University business, including: websites, newsletters, newspapers and promotional material. It is agreed that the use of the photograph/s shall in no way be used in any other forum other than for official University business.

Nominee Name:

Signature:

SECTION 3 NOMINATOR DETAILS

NamePosition/Title

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Name of School or UnitEmail Address

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SECTION 4 STATEMENT OF SUPPORT – DVC & VP/ VP/ PVC/ Dean of School /Executive Director or Director

1. Please state reasons for supporting this nomination

2. How does this application align to the Securing Success 2015-2020 Strategic Plan?

Name:Position: DVC & VP/ VP/ PVC/ Dean of School/ Executive

Director or Director(please circle or bold)

Signature:

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SECTION 5 SELECTION CRITERIA

Please provide a summary of the nomination (Max 100 words). Please note: if the nomination is successful, the summary will be included in the award booklet.

1. Demonstrate with evidence the benefits of the engagement, outreach activity or sustainability program/initiative to the University, community or business. (Maximum 500 words)

2. Indicate how this contributes to achieving our goals in Security Success? As

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applicable, also indicate how this aligns with the Sustainable Development Goals 2030. (Maximum 500 words)

SECTION 6 REFEREE REPORTS of 8

1. Referee report to support nomination

2. Referee report to support this nomination

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SECTION 7 SUPPORTING DOCUMENTATIONYou may attach three (3) to five (5) supporting documents as evidence of the achievements of the nominee(s). The documents need to be relevant and clearly support the nomination.

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Some examples of additional information are: additional letters of support testimonials a short curriculum vitae of the nominee

Please submit your application along with 7 copies to:

Manager, HR Projects and SupportOffice of Human ResourcesBuilding AEWerrington North Campus

By close of business Monday 5 September 2016

NOTE: This application will be acknowledged via email by 9 September. If you do not receive acknowledgement, please phone x7890 or email [email protected]

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mailto:[email protected]

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