2016

Endeavour Nomination Form

Nominations are to be made by the applicants host organisation(s). The person completing this form must hold a senior
position within the host organisation.
The selection process for the Endeavour Scholarships and Fellowships are merit-based and nominations do not guarantee
an offer. Nominations received after the closing date will not be considered.
Nomination forms returned directly to the department will be treated as confidential and will only be made available to the
Endeavour selection panel and administrators.
Information for potential host organisations can be found on the Endeavour website.
1. APPLICANT DETAILS
Title: Mr
Last Name: Suzuki

First Name: Hiro

Category Type:

Research Fellowship (including Research Fellowship for

Indigenous Australians and QE II)

Application ID: ERF_PDR_134977_2015

or

Executive Fellowship
Postgraduate Scholarship (Australian only)

2. NOMINATING ORGANISATION DETAILS

Title: Mr
Last Name: Smith

First Name: Michael

Position Held: Senior Researcher

Organisation: The University of Sydney

Phone: + 61 2 8435 9946

(Please include country and area codes)

Email: M.Smith_@sydney.edu.au

Postal Address
Address Line 1: 38 University Road
Address Line 2: The University of Sydney
State/Province: NSW

City/Suburb: Sydney

Country: Australia

Postcode: 2006
Have you discussed the proposed dates with the applicant?
Yes

No

Recipients must commence their proposed programme between 1 January and 30 November 2016. Please check the Endeavour website for
minimum and maximum durations. http://internationaleducation.gov.au/endeavour

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Main Round closing date: 31 July 2009

Endeavour Nomination Form Second Round closing date: 31 January 2010

2016

3. PROPOSED PROGRAMME
Please provide a brief summary of the proposed programme (maximum 300 words)

The applicants proposed programme will.......

How will the proposed programme build or improve the linkages between the home and host organisations? (maximum 100 words)

The applicants proposed programme will improve the linkages between.......

Why has the organisation chosen to nominate this applicant and what benefits will be gained from the proposed programme?
(maximum 100 words)

The organization has decided to nominate this applicant because of.........

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Main Round closing date: 31 July 2009

Endeavour Nomination Form Second Round closing date: 31 January 2010

2016

3. PROPOSED PROGRAMME (continued)

Is the applicants language ability suitable to undertake the proposed programme at your organisation?
Yes

No

Please note, if this box is ticked the applicant will be deemed ineligible and their application will
not be considered further.

Signature

Date (dd/mm/yyyy)

Michael Smith

03/05/2015

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* By typing your name into this box, it is considered that you have signed this form and all the information is true and correct
(An electronic signature is not required).
Privacy Notice
Privacy Act 1988

The department and its contractors are 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 department for the following purposes (the purposes):
assessing applications
administering the Endeavour Scholarships and Fellowships
promoting the Endeavour Scholarship and Fellowships, 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.
The department may disclose personal information in relation to applications under the Endeavour Scholarships and Fellowships for the same
purposes listed above to the following recipients:
Australian Government Departments and agencies, including Austrade, the Department of Foreign Affairs and Trade, the Department of
Immigration and Border Protection, the Australian Federal Police and the Department of Prime Minister and Cabinet
Australian Parliamentarians and Parliamentary committees
the departments contractors, including Scope Global and Cheung Kong Holdings Ltd
Australian universities, and
participating Australian organisations.

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