2013 Monash University Distinguished Alumni Awards

Nomination Form

Conditions of nomination

·  Nominations must be submitted via the online form

·  Nominations in all categories can be made by a Monash alumnus, Monash staff member or a member of the public.

·  Alumni can only be nominated in one award category in the same year

·  All nominations and supporting statements are confidential. The person being nominated should not be approached for information or advised of his or her nomination at any stage. No approach should be made to any nominee until the selection process has been completed and only the successful nominees will be contacted.

·  Alumni may not nominate themselves

·  Close family may not nominate, nor may they act as referee to a nomination

·  Nominations received after the due date (Monday, 29 April 2013, 5pm AEST) will not be accepted

·  The following alumni are not eligible to be nominated for a Distinguished Alumni Award:

o  Alumni holding political office at a local, state/provincial or national level;

o  Alumni who currently hold or have held political office within two years of the date of the close of nominations;

o  Recipients of a Monash University Honorary degree who did not also complete a Monash course;

o  Recipients of a Monash University Honorary Fellowship;

o  Members of the selection panel;

o  Advancement staff members.

·  Members of the selection panel and Advancement staff may not submit nominations, nor may they act as referee to a nomination.

*Close family refers to any of the following: spouse, ex-spouse, de-facto spouse, child or step-child (whether natural or by adoption), parent, step-parent, grandparent, step-grandparent, uncle, aunt, niece, nephew, brother, sister, step-brother, step-sister or first cousin.

Important instructions

A. There are six steps that need to be completed before nominations are submitted. The details required are as follows:

·  The nominee’s personal and professional details;

·  The nominator’s personal and professional details;

·  The nominator’s reasons for nominating, consisting of a statement against each of the selection criteria (no more than 280 words per criteria)

·  Two signed reference letters in support of the nomination, addressing each selection criteria (no more than 280 words per criteria). The referee must be a person other than the nominator, and not related to the nominee. The referee’s name and affiliation must be provided.

·  The nominee’s Curriculum Vitae (CV), including a list of their most significant publications (where applicable). The CV and bibliography must not exceed three single side A4 pages.

B. Fields marked with an asterisk (*) are compulsory.

C.To complete the nomination form, you need electronic versions of the following documents:

·  Two reference letters (preferably signed or with electronic signature appended) addressing the two selection criteria (no more than 280 words per criteria)

·  The nominee's most recent CV.

Accepted file extension types are: .jpg, .zip, .pdf, .doc, .png, .docx, .gif

Note: You will not be able to save the form at any stage and the form will not be submitted until you complete the final step and press 'submit'.

Nominations must be received by 5pm (Australian Eastern Standard Time), Monday, 29 April 2013

You will receive a confirmation message upon successful submission of your nomination. The selection process will be finalised by mid June 2013 and results will be communicated to you soon after. Only successful nominees will be contacted.

Submitting this form does not automatically imply that the nominee will be selected for a Distinguished Alumni Award. The information provided in this form will be handled in strict confidence, following Monash University's privacy regulations.

For enquiries please contact:

Alumni Relations
External Relations, Development and Alumni
Monash University

Tel: +61 3 9903 4679
PO Box 197, Caulfield East, VIC 3145, Australia

Email:

þ  Tick this box to confirm that you have the necessary documents to continue

Step 1 of 6 – About the nominee (the person you are putting forward for an award)
Nominee’s personal and professional details
Title (Mr, Ms, Dr, etc)*: / Please enter Qualification
First name *:
Last name*: / Please enter years
Suffix (e.g. AO, AM): / Please enter area of specialty
Date of birth (dd/mm/yyyy)*: / Please enter position description
Monash qualification*:
Please separate with a coma (,) if more than one. Maximum 300 characters.
Year of graduation*:
Faculty (e.g. Science, Arts)*:
Other qualifications and year of graduation:
Current business position*:
If retired, please include the last business position you held and the year finished.
Company/Organisation*:
Nominee’s contact details
Preferred email address*: / Please enter Qualification
Business hours phone number:
Please include country code and area code
After hours phone number:
Please include country code and area code / Please enter years
Mobile phone number*:
Please include country code and area code / Please enter area of specialty
Preferred postal address*:
Please include street name, number, suburb or city. Maximum 300 characters..
Country*:


Step 2 of 6 – About the nominator

Nominator’s personal and professional details
Title (Mr, Ms, Dr, etc)*: / Please enter Qualification
First name *:
Last name*: / Please enter years
Suffix (e.g. AO, AM): / Please enter area of specialty
Relationship with the nominee*: / Please enter position description
Monash alumnus, staff member or member of the public (state which):
Monash qualification:
Please separate with a coma (,) if more than one.
Year of graduation:
Faculty (e.g. Science, Arts):
Other qualifications and year of graduation:
Current business position*:
If retired, please include the last business position you held and the year finished.
Company/Organisation*:
Nominator’s contact details
Preferred email address*: / Please enter Qualification
Business hours phone number:
Please include country code and area code
After hours phone number:
Please include country code and area code / Please enter years
Mobile phone number*:
Please include country code and area code / Please enter area of specialty
Preferred postal address*:
Please include street name,number, suburb or city. Maximum 300 characters..
Country*:

Step 3 of 6 – Reasons for nomination (nominator’s statement against selection criteria)

There are two selection criteria that need to be addressed in this section:

1). Please refer to Distinguished Alumni Awards homepage for the two criteria specific to the award category you are nominating in

2). Please refer to Distinguished Alumni Awards homepage for the two criteria specific to the award category you are nominating in

Instructions

In this section you may either:

i) Upload a pre-prepared statement in one of the accepted file types. The statement must address each of the two selection criteria (280 words per criteria). The statements may be uploaded as one document or two separate documents; or

ii) Address each of the selection criteria by typing your response into the fields provided

To upload the nominator’s statements:

i. Click on the ‘Browse’ button

ii. Browse through your files and select the file that you would like to attach

iii. Click the ‘Attach this file’ button

Please note:

i. Filename: (40 characters maximum)

ii. File size: (10MB maximum)

iii. Maximum two attachments

iv. Accepted file extension types: .jpg, .zip, .pdf, .doc, .png, .docx, .gif

Browse / Attach this file / 10MB limit per attachment

Type your statement here (250 words or less for each statement):

Type your statement here (250 words or less for each statement):


Step 4 of 6 – Reference letters

Please attach two reference letters addressing the two selection criteria in no more than 280 words for each criteria (total of 560 words per reference letter). The reference letters must be from two people other than the nominator. Where possible, place reference letters on letterhead and include an electronic or scanned signature. Also include full contact details for each referee and include the referees current employment details and relationship with the nominee.

Instructions

To upload reference letters:

i. Click on the ‘Browse’ button

ii. Browse through your files and select the file that you would like to attach

iii. Click the ‘Attach this file’ button

Please note:

i. Filename: (40 characters maximum)

ii. File size: (10MB maximum)

iii. Maximum two attachments

iv. Accepted file extension types: .jpg, .zip, .pdf, .doc, .png, .docx, .gif

Browse / Attach this file / 10MB limit per attachment


Step 5 of 6 – Nominee’s CV

Please attach the nominee’s most recent CV, including a bibliography of their most significant research publications where applicable (maximum of 3 single side A4 pages, including the bibliography). Please note that additional pages will not be forwarded to the selection panel.

Instructions

To upload nominee’s CV:

i. Click on the ‘Browse’ button

ii. Browse through your files and select the file that you would like to attach

iii. Click the ‘Attach this file’ button

Please note:

i. Filename: (40 characters maximum)

ii. File size: (10MB maximum)

iii. Maximum two attachments

iv. Accepted file extension types: .jpg, .zip, .pdf, .doc, .png, .docx, .gif

Browse / Attach this file / 10MB limit per attachment


Step 6 of 6 – Checklist, confirmation and submission

Checklist
Please tick each box in this checklist to ensure you have included all necessary information and supporting documents. Nominations must be received by 5pm, Monday, 29 April 2012.
I have included:
þ  The nominee’s personal, professional and contact details
þ  My personal, professional and contact details
þ  My reasons for nominating, addressing the selection criteria
þ  Two reference letters addressing the selection criteria
þ  The nominee’s most recent CV. Maximum of three single sided A4 pages. Any additional pages will not be presented to the selection panel.

Confirmation

þ  I acknowledge that submitting this form does not automatically imply that the nominee with be selected for a Distinguished Alumni Award.

þ  I understand that this nomination and supporting statements are confidential.

The information provided in this form will be handled in strict confidence, following Monash University’s privacy regulations.

The 2013 Distinguished Alumni Awards ceremony will be held during September 2013.

For enquiries please contact:

Alumni Relations

External Relations, Development and Alumni
Monash University

Tel: +61 3 9903 4679
PO Box 197, Caulfield East, VIC 3145, Australia

Email:

Press the submit button to lodge your nomination. You will receive a confirmation message upon successful submission of the form. If you do not receive a confirmation message, please contact us on the details above. Once you have submitted the form you will not be able to view it. The selection process will be finalised by early June 2013 and results will be communicated to you and your nominee soon after.

Page 9 of 9