2017 Chancellor’s Awards for Community Engagement

Nomination form

Nomination details

Select the relevant category for this nomination (only one) / Best collaborations in building the capability of small and medium enterprise locally, nationally and internationally
Best collaborations in contributing to creating more vibrant communities
Best collaborations in building human potential across the community through intergenerational approaches
Best collaborations in improving the sustainable use of resources
Name of Activity/Project
Individual or team / Individual / Team
Nominee details
Include details of nominee or team.
If the nomination is for a team, include details for all team members. List the team leader first. / Name / Position/Work area / Extn
Community partner details (external to the University)
Include details of the community partners involved in the activity/project:
Please add more rows to the table or remove rows as required. / Name / Postal Address + Email Address / Phone number
Details of principal people proposing the nomination
If there is more than one, please give details for all nominators. / Name / Position/Work area / Extn
Supporters of nomination
Please provide details of at least two supporters of the nomination.
See Important note below. / Name / Position/Work area / Extn

Important note

One statement must come from either a Manager of Unit/ Head of School/ Head of Research/ Divisional Manager or line manager (in the case of cross-functional staff teams). The statements must indicate that they have considered the nomination and support the award submission.

An additional supporting statement must come from a representative of the benefiting community group / a community partner. The statements should describe how the activity/project has benefited the community and indicate their support the award submission. They should be electronic and accompany the nomination, which is to be submitted by email.

The full name, position and contact details (including phone number and email) of the person submitting the supporting statement should be included on the statement as the Selection Committee may wish to contact them for further information.

Supporting statements should:

•be no more than 500 words each

•address the criteria for the awards.

Please note that nominations without supporting statements will not be accepted.

Reasons for nomination

Instructions for completion

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Nomination details

Section A
Provide a brief description of the community engagement project(max 250 words).
It is important that when the Selection Committee reads this summary, they will know (1) what the project is, (2) how long it has been going on, (3) who the community partners are and (4) the benefits of the project to the community and to UniSA.
Section B
Please answer the following detailed questions relating to the project.
Answers to be brief (100-200 words each or less). / 1. Project details
1.1 How was the activity/project initiated and by whom?
(If the initiative is a research project tendered by another organisation, it is important that you indicate how the project team has extended the initiative beyond the original brief.)
1.2 What is the project timeline – when did it begin, has it been completed or is it continuing?
1.3 Why is the project significant?
1.4 What are the innovative elements of this project?
2. Community partnership details
2.1 Define/describe the community you have been engaging with.
(Location, size, demographics etc)
2.2 How and why was the target community selected?
3. Project impact
3.1 What have been the outcomes of the activity/project?
3.2 Has the impact of the activity/project been evaluated? If so, how?
3.3 Does the project provide a benefit to the community that would otherwise not be available?
3.4 Has the activity/project provided a mutual benefit to UniSA? Please describe.
4. Additional information
4.1 If there are visual elements to the project that would enable the Selection Committee to fully understand it, please provide one or two illustrations or photos.
4.2 How would the leaders of this project spend any money awarded?
(Please provide specific details. Any money awarded needs to be spent on the project or on another community engagement activity)
Endorsement from a Deputy Vice Chancellor, Pro Vice Chancellor or Chief Operating Officer

All nominations need to be endorsed by a Deputy Vice Chancellor, Pro Vice Chancellor or Chief Operating Officer as an example of a best practice community engagement activity.

When the appropriate DVC/PVC/COO has endorsed the nomination you will need to insert their electronic signature below:

STATEMENT OF ENDORSEMENT

I have reviewed this nomination in detail and hereby endorse it as an example of abest practice community engagement activity undertaken by University staff or students within my Portfolio / Division. I agree that it meets the criteria of the awards.

insert electronic signature here>

insert name and title of SMG member here>

Submitting nominations

Nominations, with supporting statements, must be emailedto by no later thanFriday 19May 2017.

For further information or assistance, please contact Juliet Mazzone on (#29083).

NOMINATION DEADLINE –Friday 19 May 2017