Provost’s Awards for Excellence- Nomination Form
Please keep this form to a maximum of two sides of A4 paper. Nominations longer than two sides of A4 (in 10pt Calibri) will not
be considered.
1) Information about the nominated person and the nominator
Nominated person’s name
Nominated person’s job title
Nominated person’s department/division
Nominated person’s contact details (phone/email)
Nominator’s name
Nominator’s contact details (phone/email)
Nominator’s relationship with nominated person
Main purpose of nominated person’s job if UCL staff (40 words max):
I wish to nominate this individual for the following UCL value:
Excellence
Collegiality and community-building
Leadership
Fairness, diversity and equality
Innovation and creativity
Environmental sustainability
(right click on the box you want to tick, select ‘properties’, and
then select default value ‘checked
2) Describe what the nominee has achieved? E.g. what they did, how they did it and the initiative and skills used.
3) What is the impact of the activities on UCL (what are the benefits for staff/ students/ customers and how many staff/
students/ customers benefit currently and are likely to benefit in the future?
4) How innovative are the activities described?
Please return completed form to m.rice@ucl.ac.uk.by the 18th September 2014.