Indigenous Consultative Committee
LEADERSHIP AWARD
Nomination Form
Objective of the Award: To recognise the efforts of a current ECU Aboriginal and/or Torres Strait Islander student, who takes responsibility for contributing in a positive way to their own and other people’s lives within the University Community and beyond.
NOMINEES DETAILSFull Name / Click here to enter text. /
Student ID / Click here to enter text. / Mobile / Click here to enter text. /
Email / Click here to enter text. /
Course Title / Click here to enter text. /
School / Click here to enter text. /
An Australian Aboriginal or Torres Strait Islander is a person of Australian Aboriginal or Torres Strait Islander descent, who identifies as an Australian Aboriginal or Torres Strait Islander, and is accepted as such by the community with which he or she lives or has lived.
Are you of Australian Aboriginal and/ or Torres Strait Islander descent? Yes No
Have you received any other scholarships during your time at ECU? Yes No
Award Criteria (to be completed by Nominee):
1)Briefly explain how you have demonstrated leadership qualities while studying at ECU. (100-200 words)
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2)List concisely activities you have participated and/or supported during your time at ECU. Explain the role you played in each.
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3)Briefly explain how your leadership and participation has made an impact on others within the University community.(100-200 words)
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4)Briefly explain how this fund will support you in your studies? (100-200 words)
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REFEREE1 DETAILS (ECU STAFF MEMBER)Full Name / Click here to enter text. /
Staff or Student / Staff Student / ID # / Click here to enter text. /
Position Title / Click here to enter text. /
School / Click here to enter text.
Email / Click here to enter text. / Phone / Click here to enter text.
Signature / Date
REFEREE 2 DETAILS (ECU PEER)
Full Name / Click here to enter text. /
Student ID #: / Click here to enter text. / Mobile / Click here to enter text. /
Email / Click here to enter text.
Signature / Date
Eligibility conditions: To be eligible for the Leadership Award, applicants must:
- Be of Australian Aboriginal and/or Torres Strait Islander descent;
- Be currently enrolled as an ECU student in a degree course;
- Have at least six months remaining before course completion;
- Study full-time on-campus; and
- Attain satisfactory academic progress.
Important: Giving false or misleading information is a serious offence under the Criminal Code Act 1995.
Declaration: I declare that the information I have supplied on this form is complete, true and correct, to the best of my knowledge. I understand that if any information is found to be incorrect, my application may be cancelled.
Signature / Date