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

Student Id Number

Contact Number

Name (incl title)Course DetailsEmail Address

TEAM

Team NameTeam LeaderStudent Id Number

Contact Number

Team Members1. Student Id

Number2. Student Id

Number3. Student Id

Number4. Student Id

Number5. Student Id

Number6. Student Id

Number7. Student Id

Number8. Student Id

Number(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 Signature:Page 1 of 7

Name:

SECTION 3 NOMINATOR DETAILS

NamePosition/TitleName of School or UnitEmail Address

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?

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

Director or Director(please circle or bold)

Signature: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)

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3. Indicate how this contributes to achieving our goals in securing success? As applicable, also indicate how this aligns with the Sustainable Development Goals 2030. (Maximum 500 words)

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SECTION 6 REFEREE REPORTS

1. Referee report to support nomination

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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.

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 Support ServicesOffice of Human Resources Building 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 vcxawards@westernsydney.edu.au

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