Uts Learning and Teaching Awards and Citations Nomination Form 2016

UTS LEARNING AND TEACHING AWARDS AND CITATIONS NOMINATION FORM 2016

UTS: Deputy vice-chancellor (eDUCATION AND STUDENTS)
Individual nomination / Team nomination / Tick () one box
Citation nomination
Award nomination
Category of award:
(For Awards only; Citation nominations to not need to select a category.) / Tick () one box
Team teaching
Individual teaching
Early career teaching
Teaching by a casual or sessional staff member
Strengthening the UTS Model of Learning
learning.futures
Integration of Indigenous Professional Capabilities into Curriculum
Academic support
Contact details (for nominee or one team representative)
Title
First and last name
School
Faculty
Mailing address
Email address
Telephone
Position (eg. level C academic)
Staff type (tick () one box) / Academic staff / Professional staff
Gender (tick () one box) / F / M / X
For team nominations:
List names of other team members:
Title / First and last name / Gender(M/F/X) / Staff type
(Academic or Professional)
Selection criteria addressed / Tick () one or more boxes
Indicate one or more selection criteria this nomination addresses. Choose those that are most relevant to the contribution described in the nomination:
Approaches to teaching and the support of learning that influence, motivate and inspire students to learn
Development of curricula, resources or services that reflect a command of the field.
Evaluation practices that bring about improvements in teaching and learning.
Innovation, leadership or scholarship that has influenced and enhanced learning and teaching and/or the student experience. This includes contribution to the development of good learning and teaching practices through leadership or mentoring.
Title of Application
To be used as the citation/award description – maximum 25 words. The title is given as an indication of the discipline or professional area:
For
Written Statementby the Nominator(s)
A short written statement (not more than 250 words) summarising the outstanding characteristics of the contributions of the nominated individual or team.*
*Note: The Written Statement by theNominee addressing the selection criteria is separate to this application form and should be attached to the submission.
(Please extend space as required)
Nominator’s declaration
I/we (nominator’s name) ______
nominate (name of nominee or team representative) ______
for a 2016UTS Learning and Teaching Award / Citation(add page with additional signatures as required).
I/We understand the nomination must be signed by at least one student or staff member:
Signature of Nominator / Date / Student/staff ID Number
Nominee’s declaration of consent
I/we (name of nominee or team representative) consent to this nomination for a 2016UTS Learning and Teaching Award / Citation.
I/we have read and understood the eligibility criteria and confirm that this application meets the criteria.
I/we understand that the Chair of the Selection Committee will seek confidential written comments on the nomination from the Dean/Deputy Vice-Chancellor who may delegate to the Associate Dean, Head of School, or Director.
I/we have attached a written statement, in accordance with the guidelines, addressing the selection criteria and demonstrating the quality of my/our contributions.
I/we have attached two written references (one A4 page each) in accordance with the guidelines.
I/we have attached Student Feedback Survey (SFS) Summary Reportfor at least the last two years, if relevant.
For Awards only.
I/we have attached supporting informationin accordance with the guidelines.Supporting information other than SFS Summary Report is optional, but recommended.
Signature (individual or team representative): / Date
Team nominations
For team nominations, each team member must also consent to the nomination:
Signature (individual or team representative): / Date
Signature (individual or team representative): / Date
Signature (individual or team representative): / Date
Signature (individual or team representative): / Date
Signature (individual or team representative): / Date
Checklist for submission of nomination / Tick ()box
Nominations submitted must include (one (1) original and 11 copies, including copies of electronic media where relevant):
Completed and signed Nomination Form
Written statement from the nominee addressing the selection criteria
Awards:no more than eight A4 pagesin Arial or Calibri 11 point font, with 2cm margins, addressing the chosen selection criteria in a way that demonstrates the quality of my/our contributions.
Citations:no more than four A4 pagesin Arial or Calibri 11 point font, with 2cm margins, addressing the chosen selection criteria in a way that demonstrates the quality of my/our contributions.
Two written references (maximum of one A4 page each, in Arial or Calibri 11 point font, with 2cm margins.) from colleagues with appropriate knowledge of the nominee’s contributions – usually other than the Dean or AssociateDean.
Supporting information from the nominee:
Awards:Student Feedback Survey Summary Reportsfor at least the last two years for applications related to for teaching in coursework subjects (or Research Supervision Feedback Survey for applications related to postgraduate supervision). In addition, supporting documentation of up to eight A4 pages or one media resource.
Citations:Student Feedback Survey Summary Reportsfor at least the last two years, for applications related to for teaching in coursework subjects (or Research Supervision Feedback Survey for applications related to postgraduate supervision). Citation applicants do not submit other supporting information.

UTS Learning and Teaching Awards and Citations Nomination Form – 20161