Applicant's contact details:

Name (required)

Position: (required)

Phone (required)

Email (required)

Applicants are to complete the following questions in the specific word length. Dot points are acceptable.

1. What Community Engagement have you been involved in over the past two years? Give a brief overview of your Community Engagement involvement. (required)
   (Up to 250 words)
   

2. 1. How is this Community Engagement activity linked to teaching, learning and research? (required)
      (Up to 150 words)
      

   2. In what ways has the community benefited from this engagement? (required)
      (Up to 150 words)
      

3. Provide a personal statement on the Community Engagement you have done and what you have learnt about yourself and the people you have been engaged with in your Community Engagement activities. (required)
   (Up to 100 words)
   

We nominate for the Staff Award for Outstanding Community Engagement. The reasons for nominating this person for the Award are attached.(required)

Nominations must be made by two persons, at least one of whom is a staff member, and the nomination must be accepted by the Nominee, as indicated below.

Nominator 1:

Name (required)

Position (required)

Phone (required)

Email (required)

Nominator 2:

Name (required)

Position (required)

Phone (required)

Email (required)

PLEASE NOTE: The Nomination must include a supporting statement from the organisation in which the Nominee has been involved in community engagement.

Supporting statement from the organisation in which the Nominee has been involved (required)

The maximum file size you can upload is 2MB

Completed forms will be forwarded to Melinda Scott
Tel: (07) 3623 7234
Fax: (07) 3623 7149
Email: Melinda.Scott@acu.edu.au