The Division of Information Technology, Engineering and the Environment (‘the Division’) have allocated funding of $200,000 for the Industry Leader in Residence program in 2017. It is anticipated that this funding will enable one or two industry leaders in residence per annum, dependent on duration and costs. Non-technical and clear language should be used throughout the application. Please refer to the accompanying Aims and Criteria for completion of your application. SECTION 1: APPLICANTS DETAILS Title: First Name(s): Surname: Position: Institute/School Correspondence from the Institute/School providing a commitment to host the nominated residence, if successful, is required. Is a copy of this Yes No (please advise reasons as to why). ☐ correspondence attached? SECTION 2: NOMINATED INDUSTRY LEADER IN RESIDENCE Name: Industry/ sector: Organisation: Phone Number: E-mail Address: Proposed length of residence: Where applicable, correspondence from the nominated resident’s employer providing a commitment to outpost their employee for the duration of the residence, if successful, is required. Is a copy of this Yes No (please advise reasons as to why). ☐ correspondence attached? SECTION 3: RESIDENCE SKILLS, KNOWLEDGE AND EXPERIENCE Provide a brief overview of the nominated industry leaders skills, knowledge and experience. Attach a copy of their CV. Is a copy of their CV attached? Yes No ☐
The Division of Information Technology, Engineering and the Environment (‘the Division’) have allocated funding of $200,000 for the Industry Leader in Residence program in 2017. It is anticipated that this funding will enable one or two industry leaders in residence per annum, dependent on duration and costs. Non-technical and clear language should be used throughout the application. Please refer to the accompanying Aims and Criteria for completion of your application. SECTION 1: APPLICANTS DETAILS Title: First Name(s): Surname: Position: Institute/School Correspondence from the Institute/School providing a commitment to host the nominated residence, if successful, is required. Is a copy of this correspondence attached? ☐ Yes No (please advise reasons as to why). SECTION 2: NOMINATED INDUSTRY LEADER IN RESIDENCE Name: Industry/ sector: Organisation: Phone Number: E-mail Address: Proposed length of residence: Where applicable, correspondence from the nominated resident’s employer providing a commitment to outpost their employee for the duration of the residence, if successful, is required. Is a copy of this correspondence attached? ☐ Yes No (please advise reasons as to why). SECTION 3: RESIDENCE SKILLS, KNOWLEDGE AND EXPERIENCE Provide a brief overview of the nominated industry leaders skills, knowledge and experience. Attach a copy of their CV. Is a copy of their CV attached? ☐ Yes No
ITEE%20Industry%20Leader%20in%20Residence%20Application%20Formsv130217.docx