VICE-CHANCELLOR’S AWARDS FOR EXCEPTIONAL
PERFORMANCE BY PROFESSIONAL STAFF
INDIVIDUAL NOMINATION COVER SHEET
Name of Individual Nominated: ........................................................................................................
School/Unit: .......................................................................................................................................
Faculty/Division: ................................................................................................................................
University Address: ............................................................................................................................
Position: .............................................................................................................................................
HEO Level: ..........................................................................................................................................
Acceptance of Nomination (nominee to sign): .................................................................................
Nominated by: ...................................................................................................................................
School/Unit: .......................................................................................................................................
Faculty/Division: ................................................................................................................................
University Address: ............................................................................................................................
Position: .............................................................................................................................................
Signature: ...........................................................................................................................................
Attachments (Please tick):
Summary of achievements related to one or both of the award criteria (3 page limit)
Supporting documentation (3 page limit)
Please submit nomination cover sheet with supporting documentation by Friday 3 June 2016 to:
Office of the Provost, Private Bag 51, SANDY BAY CAMPUS
OR by email to: Jan.Horton@utas.edu.au