Nominee information
Name
Student ID
Email
Phone
Nominee’s preferred committee(s)
Code(s):
Full list of committees (incl. codes) and terms of nomination are available online at
usq.edu.au/student-rep. Minimum GPA of 4.0 required.
Nomination statement
Provide a brief personal statement on why you feel you are an ideal candidate for
this role. All statements will be distributed to voters in the event of an election.
Signature Date
(supporting students and further information - over page)
Please write clearly
Student Representative
NOMINATION FORM
Supporting students (four required)
Supporter one
Name
Student ID
Enrolled program
Signature
Supporter two
Name
Student ID
Enrolled program
Signature
Supporter three
Name
Student ID
Enrolled program
Signature
Supporter four
Name
Student ID
Enrolled program
Signature
usq.edu.au/student-rep
CRICOS: QLD00244B NSW02225M TEQSA: PRV12081
Submission of nomination
Submit this form to Student Life either at your local ofce or by mail to
Student Life
University of Southern Queensland
Toowoomba QLD 4350
Privacy Statement
USQ is collecting the personal information on this Form for university purposes
to register your nomination for a role as a Student Representative. Your personal
information will not be disclosed to any other third party without your consent
unless required or authorised to do so by law. Your rights to access and amend your
personal information are set out in the Information Privacy Act 2009 (Qld) which
also places obligations on USQ as to how we handle your personal information.
For further information concerning Privacy, please direct any queries to the USQ
Privacy Ofcer privacy@usq.edu.au.
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