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NOMINATION FOR COMMITTEE MEMBERSHIP

You will receive notification on a successful submission.
Forms that do not have all mandatory fields ( with * ) filled will not be submitted.

Section A: Nominator Details

If you are nominating someone else, please provide the following details about yourself as the nominator. If you are nominating yourself, please fill in your own details below.

Nominator's Information

*Title

*First Name

*Surname

*Institution

*Email

Telephone

Current Position

*Is the nominee aware they are being nominated? YesNo

Section B: Nominee Details

Please provide details of the nominee.

Nominee's Information

*Title

*First Name

*Surname

*Institution

*Current Position

*Committee(s) nominated for

Nominee's Contact Information

Organisational address
line 1

Organisational address
line 2

Organisational address
line 3

City/Town

County

Post Code

*Telephone

*Email

Nominee's Merits and Qualities

*Justification as to nominee's suitability to sit on the suggested committee(s)

*Scientific Areas of research/interest

*Nominee's qualities
(Including academic/industrial background e.g. publications , grants, positions held, students supervised etc) and knowledge of the committees' subject area

*Nominee's experience of serving on STFC and non-STFC committees

Possible conflicts of interest

Section C: TO BE COMPLETED BY THE NOMINEE ONLY

Equal Opportunities Monitoring

As a public body, STFC has legal obligations to eliminate unlawful discrimination and to promote equality in all its activities. As part of our commitment to this, we collect, analyse and review equality data relating to the people we employ, award funding to and appoint to our boards, committees and panels. This helps us to monitor how successful we are in eliminating discrimination and promoting equality, and to identify any issues that need to be addressed.

We would be grateful if you would provide all the information requested as this will assist us in improving our policies and practices. However you can choose not to disclose any or all of the information. The information will be used for monitoring purposes only and will be treated in strictest confidence. The data will be processed separately from any activities concerned with the operation of the board, committee or panel you are applying for and will be reported in anonymised, aggregate form only.

Please contact Victoria Wright (victoria.wright@stfc.ac.uk) for further information.

Date of birth (dd/mm/yyyy)

Gender

Ethnic origin

Nationality

Disability

The Disability Discrimination Act 1995 defines disability as a ‘physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out normal day to day activities’.

Do you consider yourself to be disabled?

If you have any query, please contact: Janice Masone
Tel: (01793)442199
E-mail: janice.masone@stfc.ac.uk