Strictly confidential and restricted Honorary Degrees Nomination Form Proposer details Name PI or staff no. (Mandatory Field) Phone number Email address Address/Dept. Explain any relationship between the proposer and the nominee. Please write none if there is no relationship. Date Nominee details Title Date of birth Forename Email address Surname Phone number Occupation Address Type of award (Doctor or Master) Nomination Criteria Please indicate one criterion – you must select the one criterion that reflects the primary reason for your nomination: Services to the University Services to the educationally underprivileged Work in areas of special educational concern to the University Academic and scholarly distinction Public Services Services to the Arts and Sciences Exceptional contribution to education and culture Exceptionally innovative and socially responsible business developments Page 1 of 4 Nomination details (please limit your nomination to 500 words and make sure to explain how your nominee’s achievements ‘fit’ with the OU mission) Please summarise your nomination in one or two sentences following on from the phrase below: ‘I have nominated this person for this award as a result of the exceptional contribution they have made to… .’ This form should be marked 'Strictly confidential and restricted' and emailed to: Honorary-Nominations@open.ac.uk. The annual cut-off date is the end of September. If any further information is required, you may be contacted by the Honorary Degrees Committee Secretariat. Page 2 of 4 Equality and Diversity...making it happen Honorary Degree Nominations - Equality of Opportunity Monitoring It is part of the University’s equality and diversity strategy to collect and monitor age, disability, ethnicity, gender, religion and sexual orientation information. We do this so we can ensure that the University is providing opportunities to all groups of people in society, meeting our mission of being ‘open to people’ and living up to our inclusive values. Providing this information will enable us to verify if the nominations we receive represent an appropriately diverse group or whether we should take additional positive action measures to increase nominations from under-represented groups. We realise that you may not know all of the information that we are asking for and that you are not able to ask the person you are nominating in case you inadvertently disclose the fact that they are being nominated. We would like you to take a ‘best guess’ or if you are uncertain or prefer not to do this for any of the categories, to leave responses blank. Only the Secretary to the Honorary Degrees Committee and a limited number of people working with the Secretary will have access to the information you provide on this form and it will only be used for equality of opportunity monitoring purposes. The Committee will not have sight of this information in making judgements or decisions about the merits of nominations. Please return this completed form along with the nomination form. It will be separated on receipt. Thank you. Full name of person being nominated: Age Which age band does the person fall into? Please tick one box. 25 and under 26-35 36-45 46-55 56-65 66 and over Sex/Gender What is the sex/gender of the person? Female Male Other (e.g. intersex) Page 3 of 4 Disability Does the person have a disability? Yes No Under the Disability Discrimination Act, a person has a disability if he or she has a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. Substantial is defined as ‘more than minor or trivial’ and long-term is defined as ‘having lasted, or is likely to last, more than 12 months’. Impairments include sensory impairments such as those affecting sight or hearing, mental health difficulties, specific learning difficulties such as dyslexia, restricted mobility or manual skills, severe disfigurements and people living with HIV, cancer or multiple sclerosis. Ethnicity Which grouping best describes the ethnic or cultural background of the person? Please tick one box. Asian or Asian British Black or Black British Mixed ethnicity White British/Irish/Scottish/Welsh/English White Other Other ethnic group Religion or belief Does the person have a religion or belief? No religion or belief Buddhist Christian Hindu Jewish Muslim Sikh Spiritual Other religion or belief Sexual orientation What is the sexual orientation of the person? Towards people of the same sex (Lesbian/Gay) Towards people of more than one sex (Bisexual) Towards people of a different sex (Heterosexual) Other (e.g. asexual) Page 4 of 4