CONFIDENTIAL

Nomination for an Honorary Degree of the University of Birmingham

2018-19

I/we nominate the following person for an Honorary Degree:

1. / Family name
2. / Forename(s)
3. / Title
4. / Full formal style and title
(e.g.: Professor Joe Bloggs CBE FREng)
5. / Current home address or other contact address
Email
Telephone
(Please give all available information)
6. / Please indicate the preferred award:
Doctor of Divinity (DD)
Doctor of Dental Science (DDS)
Doctor of Engineering (DEng)
Doctor of Laws (LLD)
Doctor of Letters (DLitt) / Doctor of Medicine (MD) *
Doctor of Music (DMus)
Doctor of Science (DSc)
Doctor of the University (DUniv)
* May only be conferred upon persons who are already medically qualified.
7. / Current or most recent office/position
8. / Academic qualifications held (if any)
9. / Other honorary degrees and distinctions already held(if any)
10. / Reasons for the nomination(please tick all that apply)
 / Eminence in their field and work of exceptional regional, national or international significance /  / Links or recent activities with and for the University
 / Links with the City of Birmingham / the West Midlands /  / Potential for future relationship with the University
11. / Statement in support of nominee
Why should the University of Birmingham award this honorary degree?Please refer to the reasons for nomination above. Up to 300words.
12. / Other biographical information:
Please provide below a short biographical summary (such as an extract from Who’s Who) together with any further information in support of the nomination.
13. / Suggested Relationship Manager(usually the Proposer)
14. / Please outline the nominee’s current links or recent activities with and for the University, if applicable:
15. / Please outline how you expect the relationship between the University and awardee to develop. Up to 300 words.
16. / If the award is not to be made at a degree congregation at the University of Birmingham campus, please state the proposed venue and justification:
(In the majority of cases, this field will be left blank. Honorary degrees are usually conferred at a degree congregation on the University of Birmingham campus)
17. / School with which the award is associated (if any)
18. / Please describe the proposer’s/seconder’s relationship to nominee (if any)
19. / Proposer’s name
20. / Proposer’s School / Professional Service
21. / Date / Proposer’s Signature
22. / Seconder’s name
(a seconder is optional)
23. / Seconder’s School / Professional Service
24. / Date / Seconder’s Signature

Please refer to the guidance on nominations for honorary degrees when completing this form. Forms with incomplete information will be returned to the proposer.

Please send forms to: Neal Sidney, Registrar & Secretary’s Office,, 0121 414 8009.

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