International Student Research Forum (ISRF)

International Student Research Forum (ISRF)

NOMINATION FORM

Departments/Schools and nominees are asked to complete this form and forward by email with required documentation (refer checklist page 4) to Dr George Duke, MSGR General Manager () by COB Tuesday 22nd September.

Please fill in this nomination form electronically (by clicking in the boxes)

Dept/School Nominator details

1. Full name and title

Title / First name / Surname

1. Contact details

Position
Specialist scientific expertise
Department
Postal address / Postcode
Email address
Phone number
Fax number

1. Academic/professional relationship to nominee

Nominee details

1. Full name and title

Title / First name / Surname

1. Contact details

Department
Postal address / Postcode
Email address
Phone number incl area code / Business hours
Mobile
Fax number incl area code

1. Date of birth

Date of birth

7. Applicant is a:

Local student (Australian citizen or permanent resident or a New Zealand citizen) / Y or N
OR
International student / Y or N

8. Have you previously been nominated to represent the University of Melbourne at a conference or other forum. Please indicate below

9. Research higher degree studies – current enrolment

The name of your degree
(eg. PhD, Master by Research)
Which year of your research degree are you currently enrolled in?
Anticipated date of completing research degree.

10. What is the title of your thesis?

11. Describe specific aspects of your experience or recent activities which indicate your capacity to contribute to a national conference or international meeting as a representative of the University and your discipline.

Maximum 10 lines

12. Explain how attending this meeting will contribute to your studies and/or your professional development as a researcher

Maximum 10 lines

13. Please attach your publication list. (If you do not yet have any publications please indicate N/A below)

(Please attach supporting documentation)

14. Please attach your curriculum vitae.

(Please attach supporting documentation)

15. Please attach a detailed letter of recommendation from your supervisor including the specialist scientific expertise of the referee.

(Please attach supporting documentation)

Faculty Endorsement (remove if not required)

Signature

Position

Date

Comments

NOTE: It is essential that ALL sections of this form are completed to be eligible for the selection process and nomination.

CHECKLIST

Deadline for nominations:

COB: 22nd September 2009

Contact for Questions:Dr George Duke, MSGR General Manager,

Lodging your application:Complete the nomination form and submit it via email to:

Attach supporting documents:

Q13) Publication list.

Q14) Curriculum vitae.

Q15) Detailed letter of recommendation from your academic supervisor.

1