The University of Newcastle, Australia

Regional Leadership Award

* Required field

2019 Nomination form

Your contact information

Nominee contact information

Written responses

A word version of this section of the nomination form is available here for those who would prefer to save and revisit their written responses at their leisure. Once completed, this document can then be uploaded below.

Further Documentation

This section is optional although helpful to include.

Please either upload a resume (file format .doc/.docx/.pdf/.txt) or include a LinkedIn profile URL.

Declaration and authority to use information

By submitting a nomination:
  • I declare the information provided in this nomination form true and correct
  • I understand the information provided in this nomination will be used by the University of Newcastle (UON) in selecting award finalists and consent is provided to the use of such information for that purpose
  • I further consent to the use of such information for research, educational or any purposes as long as such does not divulge myidentity or the identity of the nominee to any person other than UON and their respective affiliates
  • I have read and agreed to the Nomination Guidelines and conditions

We advise that the information you provide is collected by the University of Newcastle and its contracted service providers and may be used to make you aware of future University events and opportunities. The University and its contracted service providers may use your personal information to contact you about your submission or invite you to participate in surveys or market research activities.

The University abides by the Privacy and Personal Information Protection Act 1998 (NSW), under which you have the right to access your personal information held by the University. The University’s Web Privacy Statement and Privacy and Information Access Policy provide further detail.