Vice- Chancellor’s Excellence Awards 2016Excellence in Professional Service Nomination FormSECTION 1 NOMINEE DETAILSINDIVIDUAL
Staff Id Number
Contact Number
Name (incl title)Position/ Title Length of
ServiceSchool / UnitEmail Address
TEAM
Team NameLeader NamePosition / 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 NOMINEEI/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
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:
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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. Please provide at least one (1) example which is evidence based that illustrates the outstanding nature of the contributions of this nominee. Your statement should demonstrate how the nominee has achieved excellence beyond that which is required in their position/job requirements. (Maximum 750 words)
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2. Give at least one (1) example of an innovative idea, introduced by the nominee and provide details of how this has impacted on the University. (Maximum 750 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 ResourcesBuilding AEWerrington North Campus
By close of business Monday 5 September 2016
NOTE: This application will be acknowledged via email by 9 September 2016. If you do not receive acknowledgement, please phone x7890 or email [email protected]
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