Please read the University’s Guidelines for the awarding Honorary Titles before completing this form. The guidelines are available online here: . Look under policies. Details of Person being Appointed Full Name (Including title) Mailing Address Has this person Work Permit Expiry Date previously Yes ____/____/_____ (if applicable, attached a copy) been employed by the No University of Otago? If yes, what dates? From: To: ____/____/_____ ____/____/_____ If no, please provide the appointee’s Date of Birth D.o.B.: (HR requires this in order to set up the Username for Library access) Justification for awarding Honorary Title at level recommended: Details of Position Department Honorary Role/Contribution to the University Terms of Appointment Finish Date Date of Commencement ____/____/_____ (1 3 year term) – Approval Head of Department Date ____/____/_____ Signature Dean of School Date ____/____/_____ Signature Pro-Vice-Chancellor Date ____/____/_____ Signature Special Notes
Please read the University’s Guidelines for the awarding Honorary Titles before completing this form. The guidelines are available online here: . Look under policies. Details of Person being Appointed Full Name (Including title) Mailing Address Work Permit Expiry Date (if applicable, attached a copy) ____/____/_____ Has this person previously been employed by the University of Otago? Yes No If yes, what dates? From: ____/____/_____ To: ____/____/_____ If no, please provide the appointee’s Date of Birth (HR requires this in order to set up the Username for Library access) D.o.B.: Justification for awarding Honorary Title at level recommended: Details of Position Department Honorary Role/Contribution to the University Terms of Appointment Date of Commencement ____/____/_____ Finish Date (1 – 3 year term) Approval Head of Department Signature Date ____/____/_____ Dean of School Signature Date ____/____/_____ Pro-Vice-Chancellor Signature Date ____/____/_____ Special Notes
otago074605.docx