FORM 2: EXTENSION OF HONORARY, ADJUNCT, VISITING, ASSOCIATE ACADEMIC, AND SENIOR INDUSTRY FELLOW APPOINTMENT FORM

Please forward the completed form to Human Resourcesno later than 3 months prior to the end date of the appointment. If advice of the extension of Honorary, Adjunct or Visiting Academic Appointment is not received by the due date, Human Resources will take appropriate action to terminate the appointment and all privileges will be suspended.

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 extension: / Original end date:: / Proposed end date:

2 Extension of 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 Contribution from previous appointment

4 Expected outcomes from extension [please provide role, duties and benefit to School, College, Portfoliio and the University]

  • the duties and responsibilities of the proposed appointee;
  • 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 School / College / Portfolio 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 if different from original application]

5 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 in different from original application]]

6. 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

Approval

Recommended by Head of School/Dean/Director of Centre/Institute:
Name: / Title:
Signature: / Date:
Extension approved by Pro Vice-Chancellor and Vice-President
Name: / Title: / Pro Vice-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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