Faculty of health sciences



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2016 Alumni Awards
Nomination Form

Please ensure you review the submission guidelines before completing this form – further information about the Faculty of Health Alumni Awards can be found at sydney.edu.au/health_sciences/alumni/awards


We encourage you to submit supporting documentation with your nomination. All nominations and supporting statements are confidential.

Only alumni (graduates of the University of Sydney), or University of Sydney students who have met their degree requirements may be nominated.
About you
Title: _ _ First name: ____________________ Last name: ____________

(Prof, Dr, Mrs etc)


Address:
________________

________________
State: _________ Postcode: ___________________ Phone: _________________
Email address: __________________________________________________________________
Address type: Home Work
Graduation details:

(If applicable, list University of Sydney degree/s and graduation year or expected completion date)



Tell us about your nominee
Title: _ _ First name: ____________________ Last name: ____________

(Prof, Dr, Mrs etc)


Address:
________________

________________
State: _________ Postcode: ___________________ Phone: _________________
Email address: __________________________________________________________________
Address type: Home Work
Graduation details:

(if applicable, list University of Sydney degree/s and graduation year or expected completion date)



Professional details:


Organisation: ________ ________________ Position: ______________ _____________
Graduation details:

(If applicable, list University of Sydney degree/s and graduation year or expected completion date)


Nomination for Award category (please choose only ONE category per nomination)

Achievement Awards

 Alumni Award for Community Achievement

 Alumni Award for International Achievement

 Alumni Award for Professional Achievement

 Young Alumni Award for Achievement

 Recognition Award for Clinical Education



Checklist
For the nomination, I have included:
 A statement outlining why your nominee is worthy of an Alumni Award. You should read the submission guidelines for the relevant award at sydney.edu.au/health_sciences/alumni/awards

 Supporting documentation for these awards should include why you think your nominee is a worthy candidate. (Suggested word length 500 words).

 Letters supporting the nomination from employers, distinguished members of the public, academic supervisors and other senior University staff are encouraged.

 If available, documentary evidence such as newspaper clippings, copies of certificates, etc of your nominee's achievements and activities.

 A curriculum vitae where available should also be included (however please do not include individual lists of journal publications, peer reviewed articles etc - this should just be summarised).

Closing Date for Nominations: 5pm Friday 25 March 2016
Please send nominations and supporting statements to:
MARIA HUMPHREYS 
Manager, Alumni & External Engagement
Faculty of Health Sciences 
The University of Sydney

         75 East Street  | Lidcombe | NSW | 2141  


                    
T
+61 2 9351 9806 | F +61 9351 9863
E maria.humphreys@sydney.edu.au


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