DGFU Nomination Form

Details of the nominee

Family name:
Given names:
Occupation:
Address:
Date of birth:
Telephone:
Fax:
Email:
Student number, if known:
UNE qualifications and date:
Other tertiary qualifications, institution and date:

Details of the proposer

Why you think the person is worthy of the award?

Please describe, against the award criteria, the qualities, contributions, initiatives and career achievements which you think make your nominee worthy of a Distinguished Graduate Fellow of the University (no less than 500 words).
You may also list the range of voluntary activities your nominee engages in such as membership of professional groups and service organisations, relevant to this nomination.
Please supply documentary evidence such as newspaper clippings, copies of certificates etc to support this nomination.

If you are unable to supply electronic copies, please send them as a fax (02 6773 3285) or post to: DGFU, Alumni Relations Officer, UNE ARMIDALE NSW 2351

By submitting this form, you are certifying that the information supplied is true.

Edit This Favorite