FORM 1: HONORARY, ADJUNCT, VISITING, ASSOCIATE ACADEMIC, AND SENIOR INDUSTRY FELLOW APPOINTMENT FORM

Please forward this completed form to Human Resources together with a copy of the nominee’s full academic Curriculum Vitae, and referee reports (if required).

1. Nominee Personal Details

Title: / Surname: / Given Name:
Address: / Post Code:
Country:
Telephone: / Email:
Institution: / Is a visa required: / Yes No
Citizenship/Residency: / Visa type: / [select]
Period of Appointment: / Commencement Date:: / End Date:

2. Appointment Sought [please select one]

Honorary Appointment
Honorary Professor
Honorary Associate Professor / Honorary Principal Research Fellow
Adjunct Appointment
Adjunct Professor
Adjunct Associate Professor / Adjunct Principal Research Fellow
Visiting Appointment
Visiting Professor
Visiting Associate Professor
Visiting Research Fellow
Associate Appointment
Associate
Clinical Associate
Senior Industry Fellow
Negotiated Casual Rate [please specify rate in AUD$]

3. Expertise [please provide an account of the nominee’s area of expertise, how they meet the eligibility for appointment and attach current CV]

4. Purpose of the appointment and expected outcomes [please provide role, duties and benefit to School, College, Portfolio and the University]

  • the proposed duties and responsibilities (for visiting academics please outline the objective of proposed visit or details about the research project the visitor will be involved in)
  • how the appointment will advance the University’s contribution to research, teaching, community or professional service or the University’s links with industry or government;
  • the benefits that will flow through to the College / School from the appointment; and

5. Physical Resource to be provided to nominee [provide details of physical resources that will be required eg: campus location (onshore/offshore), office space, computer, access to email, access to RMIT libraries]

6. Financial Resource provided to nominee [provide details of any financial expenses that will be met by the School/Area eg: travel costs, accommodation, living expenses]

7. Visa Requirements [if applicable]

Please detail visa requirements and the name, relationship and date of birth of any family members who will accompany the academic during their stay.
Visa information from Central Recruitment Unit or
Visa requirements approved via Human Resources Y/N

Nomination and Approval

Recommended by Head of School/Dean/Director of Centre/Institute::
Name: / Title:
Signature: / Date:
Endorsed by:
Name: / Title:
Signature: / Date:
Approved by Pro Vice-Chancellor and Vice-President
Name: / Title: / ProVice-Chancellor and Vice-President,
Signature: / Date:

For information on the collection, storage and privacy of the personal information provided on this form, please visit:

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