FACULTY OF HEALTH SCIENCES
2015 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
(Prof, Dr, Mrs etc)
name: ____________________ Last name:
____________
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
(Prof, Dr, Mrs etc)
name: ____________________ Last name:
____________
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 27 March 2015
Please send nominations and supporting statements to:
MARIA HUMPHREYS
Alumni Relations Manager
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
Faculty of Health Sciences
+61 2 9351 9806
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