Science and Mathematics Excellence Awards

Application Form

This template must be completed by the applicant. If the application is from a team or school, the lead applicant should complete this form. Applications close Friday 13 May 2011. Please address each field.

[Note: This template must be completed using Microsoft Word and must be attached and submitted via email to your Regional Contact. Please do not send in PDF or scanned/handwritten format.]

SECTION 1

CONTACT DETAILS OF APPLICANT/TEAM REPRESENTATIVE
Family Name / Title / Gender
Given Name/s
Edumail address
ID Number
SCHOOL DETAILS
School Name
School Number
School Address
Postcode
Telephone number
Region
PRINCIPAL’S ENDORSEMENT
Name of Principal
Endorsed – Yes / No / Signature:
REGIONAL ENDORSEMENT
Name of Regional Network Leader
Endorsed – Yes / No / Signature:

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OTHER KEY TEAM MEMBERS

PLEASE NOTE: THIS APPLIES ONLY TO A “TEAM” APPLICATION

TITLE / GIVEN NAME / SURNAME / EMAIL ADDRESS / SCHOOL NAME
INDUSTRY PARTNER/S
ORGANISATION / ADDRESS / CONTACT NAME / CONTACT NUMBER / EMAIL

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SECTION 2

SELECTION CRITERIA PART A: PROFESSIONAL EXCELLENCE

Applicants must be exemplary representatives of the teaching profession.

‘Industry’ partners may include businesses, universities, TAFEs, community organisations and not-for-profit organisations.

Please respond to each of the following criterion in 200 words or less.

1. Describe the partnership between the school and the industry.
Include in your response how the partnership supports innovative approaches to science and/or mathematics education.
2. How does the partnership support greater student engagement in science and mathematics?
3. How does the partnership with industry increase student awareness of real world applications of science and/or mathematics and knowledge of career pathways?
4. Is there any evidence of improved student outcomes in student achievement and engagement in science and/or mathematics?
SELECTION CRITERIA PART B: AWARD PROPOSAL

Describe (in no more than 300 words) how this funding will be used to consolidate, expand or promote the industry partnership with reference to the following questions:

  • What are the expected outcomes of your proposal, and how will these benefit you, your school and/or the education system?
  • How will the outcomes be shared and replicated beyond a single classroom? For instance in your network or on FUSE.
  • What is the strategy for evaluating the impact of the proposal?

[Please refer to the Award guidelines for useful links].

Title of proposal
Description

SECTION 3

REFEREE DETAILS

In support of this application, the contact details of two referees must be provided. As a general guide, referees may focus on the achievements to date and why the applicant/s is/are outstanding.

Please provide details of the selected referees:

FIRST REFEREE
Name
Telephone number
Email address
Relationship to applicant/s
SECOND REFEREE
Name
Telephone number
Email address
Relationship to applicant/s

ALL MATERIAL IS CONFIDENTIAL

Enquiries relating to this process should be directed to your regional contact.

Applications close on Friday 13 May 2011

Science and Mathematics Excellence Awards 2011 – Application Form

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