Nomination form to be submitted to grantsandawards@jcu.edu.au by the relevant
College ADLT by Monday, 2 September 2019
Select relevant:
Individual nomination
Team nomination
Contact details (for nominee or lead representative of a team)
Title
First name
Last name
Discipline
/ Division /
College
/
Administrative unit
Primary campus of the
nominee
Email address
Telephone
Facsimile
Postal address
Position title
Staff type
Academic staff
General staff
Gender
Female Male
Citation Wording
1 | P a g e
Describe the distinctive contribution of the nominee/s maximum 25 words.
JCU Citations for Outstanding
Contributions to Student Learning
JCU Citations for Outstanding Contributions to Student Learning 2019
2 | P a g e
Form updated 21/05/2019 AWL
Selection Criteria
P
lease nominate ONE selection criteria for assessment, as appropriate for the nominee(s)’s particular contribution.
1.
Approaches to the support of learning and teaching that influence, motivate and inspire students
to learn
2. Development of curricula, resources and services that reflect a command of the field
3.
Evaluation practices that bring about improvements in teaching and learning
͘
4.
Innovation, leadership or scholarship that has influenced and enhanced learning and teaching
and/or the student experience
F
or team nominations only:
Please list all members if more than five, a separate list may be attached.
First and last name
Gender
Staff type
Email Address
*Use one of the following, as appropriate:
F = Female
M = Male
A = Academic Staff
G = General staff
Team nominations (six or more members)
Team name
List numbers of team members, including all team members previously mentioned
Female
Male
Total
Academic Staff
General Staff
C
hecklist information for nominee
The submitted nomination must include the following:
Completed and signed Nomination Form
Written statement, as described in the JCU Citations for Outstanding Contributions to Student
Learning Application Guidelines
Two references, as specified in JCU Citations for Outstanding Contributions to Student Learning
Application Guidelines
Formatting checklists contained within the JCU Citations for Outstanding Contributions to Student
Learning Application Guidelines completed and formatting rules adhered to
JCU Citations for Outstanding Contributions to Student Learning 2019
3 | P a g e
Nominee's Declaration
I/We (print name of nominee or team rep.) ………………..………………………………………… accept nomination for a JCU
Citation for Outstanding Contributions to Student Learning.
This
application is an Early Career Category nomination (tick if yes):
Signature
Date:
As
sociate Dean Learning & Teaching Declaration
I ………………..…………………………………………
have read and support this nomination for a JCU Citation for Outstanding
Contributions to
Student Learning.
Signature
Date:
De
an of College Declaration
On behalf of this College, I support this nomination on the basis of the attached application. This College
undertakes to support this/these nominee/s in activities to disseminate good practice in learning and
teaching. I confirm that the information above is true and correct and that the nominee(s) referred to on this
form is/are currently a staff member or associate of this College.
Name
Signature
College
Date:
Divisional DVC Declaration
On behalf of this Division, I support this nomination on the basis of the attached application. This Division
undertakes to support this/these nominee/s in activities to disseminate good practice in learning and
teaching. I confirm that the information above is true and correct and that the nominee(s) referred to on this
form is/are currently a staff member or associate of this Division.
Name
Signature
Division
Date:
Document updated 21/05/2019 AWL
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