HDR09 – higher degrees by researchqualifying panel nomination form

This form is used to nominate person(s) who are agreeable to acting as member(s) of a Qualifying Panel. This role will entail assessment of a HDR candidate's written and oral research proposal which will be in a discipline relevant to the nominee's area of expertise. This form provides information about the nominee's knowledge and expertise in the given discipline area. This information will be accessible to the candidate, their Supervisors, the HDR Coordinator and the Research Committee.

This form is designed to be completed electronically before it is printed. Please complete as much of this form as possible on a computer before you print the form.

SECTION 1 – candidate DETAILS

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2

Surname
Given names

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2

HDR Program name / Masters of Indigenous Perspectives
Doctor of Philosophy Indigenous Perspectives
Research topic under review

SECTION 2 –nominee DETAILS

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2

Titlee.g. Mr, Miss, Dr
Panel nominee surname
Panel nomineegiven names
Current position

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2

Highest qualification
Phone

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2

Email
Institutional/ community and/or industry affiliations

Brief account of expertise in the area of the candidate’s research topic.

Brief account of experience in cross-cultural or Indigenous contexts.

Awareness of Indigenous perspectives/ knowledges.

Has an informal approach been made to the nominee regarding their availability to act as a Qualifying Panel member?Please advise date contacted and nominee's tentative availability.

Primary Supervisor signature______Date______

Nominee signature (optional)______Date______

HDR Coordinator signature______

Date nomination received______

Please return this form by email to the HDR Coordinator at or refer to the top of the form for alternative return address options.

This information will be stored and used at Batchelor Institute in accordance with the Northern Territory Information Act.

If you have any queries regarding storage and collection of your information, please contact the Institute at or phone (08) 8939 7111.

Authorising Officer – HDR Coordinator – Updated13/02/2017Review13/02/2018 Version 1.2Page 1 of 2