Honorary Awards Nomination Form

Curtin University Fellow

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

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

enhancing the standing and reputation of the University; and

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 Curtin University Fellow Procedures for further information regarding this Honorary Award and to assist with completing the nomination form.

The award of Curtin University Fellow will normally be conferred in perpetuity.

Recipients of the award of Curtin University Fellow are entitled to use the title in all situations and for all correspondence, as long as the title remains valid.

Criteria for Awards

Curtin University Fellow
The criteria for the award of Curtin University Fellow are that the nominee:

has served as an exemplar to the staff and students of the University (which includes global campuses) through their initiative and leadership or distinction in any field of endeavour related to the University; or

has influenced the character of the University through their interest in the University and by virtue of their professional standing within the community.

Please contact the Secretariat on Email: secretariat@curtin.edu.au for assistance with completing this Honorary Award Nomination.

Nominee Details

Nominations must at all stages be treated confidentially. A nominee must not be advised of or consulted about their nomination at any stage.

Title
First name
Last Name
Occupation/Profession
Postal address
Contact phone number/s
Email address

Statement supporting the nomination, including eligibility criteria

Please provide clear and detailed information justifying the nomination and describing how the nominee: has served as an exemplar to the staff and students of the University through their initiative and leadership or distinction in any field of endeavour related to the University; OR has influenced the character of the University through their interest in the University and by virtue of their professional standing within the community. (maximum 500 words)

Corporate Communications

Please provide a summary of the nominee’s distinguished service and commitment to the University or the rationale for the nomination for the award. This information will be provided to Corporate Relations to be used for media releases and news stories (both internal and external). (maximum 100 words)

Inscription for the award certificate

This is the inscription to be printed on the award certificate. It reflects the rationale for the conferral of the honorary award. (maximum 28 words)

Curriculum Vitae and Referees

Curriculum Vitae or Summary Profile/Biography

Please attach a succinct and contextualised summary, as well as an abridged version of the curriculum vitae 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.

(Maximum 10 pages)

CV or Summary Profile Attached	☐

Referees

Please provide two (2) referees who can be contacted regarding the nominee and this nomination as part of the initial due diligence process. Referee reports can be provided with nomination, where available.

Referee 1	Referee 2
Title
First name
Last name
Occupation/Profession
Contact phone number/s
Email address

Nominator Details and Certification

Council members and staff of the University may provide nominations for a Curtin University Fellow:

Nominations made by a member of Council, the Vice-Chancellor or an Executive Manager* may be submitted directly to the Secretariat;

Nominations made by other members of staff must be submitted to the Secretariat through their Executive Manager*

(*Deputy Vice-Chancellor/Pro Vice-Chancellor/Vice-President/Provost/Chief Financial Officer/Chief Strategy Officer/Chief Operating Officer/Chief Legal Officer).

Name of Nominator
Position Title
Contact phone number/s
Email address
Length of time the nominator has known the nominee
Nature of relationship the nominator has with the nominee

Name of Executive Manager (if applicable)
Position Title
Contact phone number/s
Email address

I certify that the information provided on this nomination form is accurate, and to my knowledge, the nominee is of good fame, integrity and character and demonstrates Curtin’s Values.

Signature of Nominator
Date

Name of Executive Manager (if applicable)
Date