MARITIME AUSTRALIA - INNOVATION AWARDS 2017

MARITIME AUSTRALIA
YOUNG INNOVATOR SCHOLARSHIP FOR CIVIL INDUSTRY – 2017
 
ENTRY FORM
 
1. Name, Address and Date of Birth of Nominee:
Name:
Address:
Date of Birth:
 

2. Declaration of Australian Citizenship:
 

3. Current job description of Nominee:
 
   
 

4. Name and address of Nominee's Employer:
Name:
Address:
 

5. Name, Job Title and Employer of Nominator: (if other than the Nominee)
(include phone number, email and postal address)
Name:
Job Title:
Employer:
Phone:
Email:
 

6. Brief Description of Project on which Nominee worked:
(attach additional pages if necessary - marked as Annexe A)
Upload Additional Information:
   

7. Description of Nominee’s Contribution to the Project:
(attach additional pages if necessary - marked as Annexe B)
Upload Additional Information:
   

8. Description of Nominee’s Originality and Innovativeness in meeting the challenges of the project concerned:
(attach additional pages if necessary - marked as Annexe C)
Upload Additional Information:
   

9. If successful, how will the Nominee use the Scholarship to advance his/her career?

(NB – the Nominee has the right, when approached by MAL, to decline the nomination for any reason he or she may choose. Deliberately falsifying data on the entry form will result in immediate disqualification)

 

10. Name and Approval of Authorised Nominee:
Name:
Job Title:
Date:
Acceptance: