Australia-APEC Women in Research Fellowship 2015 APPLICANT SPONSOR NOMINATION FORM APPLICANTS DETAILS Full Name NOMINATED AUSTRALIAN ACADEMIC INSTITUTION/ ORGANISATION Supervisor Title Supervisor Name Organisation Position Email Phone Postal address City Proposed start and end dates: Postcode How will the proposed programme build or improve regional linkages (maximum 200 words) Why has your organisation chosen to support the applicants application and what benefits will be gained from the proposed programme? (maximum 300 words) Please provide any further information that may impact the applicants application for the Australian-APEC Women in Research Fellowship (maximum 200 words) In what language have you agreed to supervise the applicant's research? Supervisors please note that applications will close 5:00pm 3 April 2015 Melbourne time. If you have any queries on the Australia-APEC Women in Research Fellowship please call Miss Cassandra Oaten from the Australian APEC Study Centre on +61 (3) 9925 1096 or contact via email: cassandra@apec.org.au Please note that we will publish details of all successful recipients on the Australian APEC Study Centre website: www.apec.org.au by 15 May 2015. Privacy Notice Privacy Act 1988 The fellowship is bound by the provisions of the Privacy Act 1988 (Privacy Act). Schedule 1 of the Privacy Act outlines the Australian Privacy Principles (APPs), which prescribe the rules for handling personal information, including sensitive information. Information collected in this form will be used by the Australian APEC Study Centre for the following purposes (‘the purposes’): • assessing applications • administering the Australia-APEC Women in Research Fellowship • promoting the Australia-APEC Women in Research Fellowship, including in promotional material, information and publications in hardcopy and/or on the internet, and • congratulating and/or inviting successful recipients to functions and events held in Australia and overseas. Do you agree to offer the necessary support to the above mentioned applicant's research at your organisation/ institution? (Please tick) Yes Have you read/understood the guidelines of the Australia-APEC Women in Research Fellowship? (Please tick) Yes Signature (Please type or sign you name into the box below if you agree to all information contained in this Applicant Sponsor Nomination Form) Date