QUT Faculty of Engineering would like to offer the Indigenous Australian students of your school the QUT Dean’s Award for Engineering, and Design Prize, for both a Year 11 and a Year 12 student with the highest academic result in their cohort. Please make nominations where indicated below.

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1. School's Full Name (No Abbreviation) (Required.)

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2. Mailing address for the awards (P.O. Box or school address)

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3. Nominating Teacher Contact Name (Required.)

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4. Nominating Teacher Position/Title

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5. Nominating Teacher's Best Contact Phone Number

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6. Nominating Teacher's Email

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7. Year 11 Engineering award winner ~ Indigenous Australian students (if none, please mark n/a)(no tie nominations) (Required.)

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8. Year 12 Engineering award winner ~ Indigenous Australian students (if none, please mark n/a)(If a tie nominations, we will provide a JB Hi-Fi- Gift card while the school will sponsor another one. However, we will honor both's bursary of $3,000 if they both enrol at QUT later) (Required.)

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9. Year 11 Design award winner ~ Indigenous Australian students (if none, please mark n/a)(no tie nominations) (Required.)

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10. Year 12 Design award winner ~ Indigenous Australian students (if none, please mark n/a)(If a tie nominations, we will provide a JB Hi-Fi- Gift card while the school will sponsor another one. However, we will honor both's bursary of $3,000 if they both enrol at QUT later) (Required.)

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11. How will the awards be presented?

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12. Estimated date award is required by (Please note an allowance of 7 days for Production of certificate & letter, and postage delivery prior to the required date. Please don't leave it to the last moment, thank you!)

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13. Will you require a QUT representative to present the award/s? (Please communicate with your school's administration team if they already have a delegate in mind before you answer this question.)

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