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Honorary Awards Nomination FormTitle of Emeritus Professor Title of John Curtin Distinguished Emeritus Professor

Honorary Awards are awarded by the University for the purposes of:

a) formally and publicly recognising the exceptional or distinguished contribution of an individual to the University, the broader society or a field of academic endeavour;

b) enhancing the standing and reputation of the University; andc) expanding or building on existing relationships.

Honorary Awards are prestigious honours, intended to recognise substantial achievements or contributions by individuals.

Please refer to the Honorary Awards Policy and Titles of Emeritus Professor and John Curtin Distinguished Emeritus Professor Procedures for further information regarding this Honorary Award and to assist with completing the nomination form.

1.0Nominee’s Details

1.1Nominations will at all stages be treated confidentially. A nominator may, however, advise a nominee of their nomination, to enable them to provide information to support the nomination. The nominator must, however, advise the nominee that a nomination does not guarantee that the title will be awarded.

Title

First name

Last Name

Position Title

Faculty or Area

Contact phone number/s

Email address

2.0Nominator’s Details

Only the Vice-Chancellor and Executive Managers* may provide nominations for the Titles of Emeritus Professor and John Curtin Distinguished Emeritus Professor.(* Deputy Vice-Chancellor/Pro Vice-Chancellor/Vice-President/Chief Financial Officer/Chief Strategy Officer).

Name of Nominator

Position Title

Contact phone number/s

Email address

3.0Nomination for Honorary Award Title

Honorary Awards that may be conferred by Council are:Please tick

Emeritus ProfessorEligibility of Nominee:

a) is normally within six months of retirement from academia or has retired from Curtin University for no more than six months; and

b) held the title of Professor at Curtin University at the time of their retirement.

__________________

Date of Retirement

John Curtin Distinguished Emeritus ProfessorEligibility of Nominee:

a) is normally within six months of retirement from academia or has retired from Curtin University for no more than six months; and

b) held the title of John Curtin Distinguished Professor at the University at the time of their retirement.

__________________

Date of Retirement

3.1The titles Emeritus Professor and John Curtin Distinguished Emeritus Professor will normally be awarded for life.

3.2The use of the titles Emeritus Professor and John Curtin Distinguished Emeritus Professor will be suspended for any recipient who returns to employment at the University, but will be reinstated if they subsequently retire or resign.

3.3The titles Emeritus Professor and John Curtin Distinguished Emeritus Professor may not be held concurrently with that of Adjunct Professor.

4.0Eligibility for Nomination

Please provide clear and detailed information justifying the proposed Honorary Award Title against the specific criteria for the award the nominee is being nominated for.

4.1Emeritus Professor and John Curtin Distinguished Emeritus Professor:

The criteria for the award of the Titles Emeritus Professor and John Curtin Distinguished Emeritus Professor:

a) has demonstrated distinguished service and commitment to the University over a period of normally five years of continuous service prior to retirement.(There is no word limit)

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5.0 Continued High Level Research Activity.

Please indicate whether a request for funding support to continue high levels of research activity has been received from the nominee:

Yes

No, but will be received

No

Please refer to the Titles of Emeritus Professor and John Curtin Distinguished Emeritus Professor Procedures under Section 2.7: Benefits and entitlements of recipients, for the procedure on applying for funding to support research activity.

6.0 Certification

6.1 Curriculum Vitae or Summary Profile/Biography:Please attach a curriculum vitae or other summary of the nominee's qualifications, employment history, career highlights, university and community service contributions, significant other awards received, and (where appropriate) publications and other scholarly or professional achievements.

CV or Summary Profile Attached:

6.2 Length of time the nominator has known the nominee:

6.3 Referees:Please provide two (2) referees who can be contacted regarding the nominee and this nomination as part of the initial due diligence process.

1. Referee:Title

First name

Last Name

Occupation/Profession

Contact phone number/s

Email address

2. RefereeTitle

First name

Last Name

Occupation/Profession

Contact phone number/s

Email address

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I certify that the information provided on this nomination form is accurate, and to my knowledge, the nominee is of good character and embodies the values of the University.

Name of Executive Manager

Signature of Executive Manager

Date

Please contact Leanne Haggart, Committee Services and Project Officer, Secretariat on Phone No: 9266 3296 for assistance with completing this Honorary Award Nomination.

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