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Vice-Chancellor’s Excellence Awards 2016Excellence in LeadershipNomination Form – Academic StaffSECTION 1 NOMINEE DETAILSINDIVIDUAL

Staff Id Number

Contact Number

Name (incl title)Position/ Title Length of

ServiceSchool / UnitEmail Address

SECTION 2 ACCEPTANCE OF NOMINATION BY NOMINEEI hereby give my permission for the University of Western Sydney, to use my photograph in official University business, including: websites, newsletters, newspapers and promotional material. It is agreed that the use of my photograph shall in no way be used in any other forum other than for official University business.

Nominee Name:

Signature:

SECTION 3 PLEASE COMPLETE ONE OF THE OPTIONS BELOW (a or b)SECTION 3a NOMINATOR DETAILS

NamePosition/TitleName of School or UnitEmail Address

SECTION 3b ENDORSEMENT OF NOMINATION BY SUPERVISOR

Supervisor NamePosition/TitleName of School or UnitEmail Address

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SECTION 4 STATEMENT OF SUPPORT – DVC & VP/ VP/ PVC/ Dean of School /Executive Director or Director

1. Please state reasons for supporting this nomination

2. How does this application align to the Securing Success 2015-2020 Strategic Plan?

Name:Position: DVC & VP/ VP/ PVC/ Dean of School/ Executive

Director or Director(please circle or bold)

Signature:

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SECTION 5 SELECTION CRITERIA

Please provide a summary of the nomination (Max 100 words). Please note: if the nomination is successful, the summary will be included in the award booklet.

1. Provide a brief summary demonstrating excellence in key aspects of personal and interpersonal capability, for example self regulation, decisiveness, commitment and having a high ethical and professional standard, rising to challenges and the ability to work productively with a diverse range of people. You should provide letters/emails/materials to support your statement (if available) You should provide examples of the nominee demonstrating excellence in problem solving, demonstrating transparency, accountability and responsibility. (Maximum 750 words)

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2. Provide a brief summary demonstrating excellence in listening, linking and leading in the workplace through consultations with staff, providing opportunities for open and genuine communication, inspiring the team and implementation of innovative ideas and linking consultations with real outcomes. Example(s) of demonstrating excellence in leading change in a consultative and meaningful manner should be included. Supporting documentation from the nominee’s peers, colleagues and staff should be provided where available. (Maximum 750 words)

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3. Provide a brief summary demonstrating a high level of understanding and competence in learning and teaching and relevant research. (Maximum 500 words)

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4. How does this application align to the Securing Success 2015 – 2020 Strategic Plan? (Maximum 500 words)

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SECTION 6 REFEREE REPORTS

1. Referee report to support nomination

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2. Referee report to support this nomination

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SECTION 7 SUPPORTING DOCUMENTATIONYou may attach three (3) to five (5) supporting documents as evidence of the achievements of the nominee(s). The documents need to be relevant and clearly support the nomination.

Some examples of additional information are: additional letters of support testimonials a short curriculum vitae of the nominee

Please submit your application along with 7 copies to:

Manager, HR Projects and Support ServicesOffice of Human ResourcesBuilding AEWerrington North Campus

By close of business Monday 5 September 2016

NOTE: This application will be acknowledged via email by 9 September 2016. If you do not receive acknowledgement, please phone x7890 or email [email protected]

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mailto:[email protected]

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