Innovation Hero Nomination Form 2013

Warren Centre Medal

These annual awards are made by the Warren Centre in each case to someone who has taken a new technology, developed it, turned it into a product or service, raised capital and commenced sales. The products must originate from activities in Australia. The commercialisation should be profitable, and significant financial benefits should flow to Australia. The award recipients should be Australian citizens or residents.

The products or processes will feature high achievements in engineering technology.

Each Award consists of the University of Sydney, Faculty of Engineering, Warren Centre medal, and a framed certificate. This will normally go to the individual responsible for driving the innovation to success, but when appropriate will be awarded to a team.

For the person being nominated:

Name
Address
State / Postcode
Email
Telephone
Innovating Organisation
Nominee’s Management Position
Organisation Address

For nomination of a team:

If the innovation’s success was the result of essential involvement with some other team members, please provide the personal information requested above for each. Also explain the reasons for your support.

For the following items, please take as much space as needed

Describe the owners of the company and all other significant investors
Describe the innovation being submitted for this award.
Was the technology conceived and developed in Australia?
Why is this superior to alternatives that may exist?
What is the status of its use or commercialisation?
What sales have this innovation generated and what is the profitability? What other funds have flowed to Australia? Quantitative information is required.
What other tangible and intangible benefits have this produced?
Are there any significant issues or problems associated with this innovation or its commercialisation?
State what the intellectual property rights are for this innovation.
What other recognition has been afforded to this product, service or innovator?

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For the person submitting this nomination:

Name
Address
State / Postcode
Email
Telephone
Management Position

Please give the name, address & email address for two independent referees.

Referee 1

Name
Address
State / Postcode
Email
Telephone

Referee 2

Name
Address
State / Postcode
Email
Telephone
Please send this completed nomination by email to:
Chief Operating Officer
The Warren Centre for Advanced Engineering,
Sydney University
/ Supplementary brochures etc. may be mailed to:
Chief Operating Officer
The Warren Centre for Advanced Engineering
Engineering Link Building J13
Sydney University NSW 2006

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The Warren Centre for Advanced Engineering Ltd
Engineering Link Building, J13 THE UNIVERSITY OF SYDNEY NSW 2006  Telephone (02) 9351 3752  Facsimile (02) 9351 2012

Email:  Internet:  ABN: 27 132 821 688

Established within the Faculty of Engineering in 1983 to mark 100 years of engineering education at The University of Sydney