Information provided on this form will not be sent to reviewers but will assist in the administration of the nomination process. Please consult the ‘NTFS Individual 2010 Awards Guidelines’ before submitting your application. If you have any queries regarding this form please contact ntfsindividual@heacademy.ac.uk.

Please note that section 4 ‘Affirmation of institutional support for a National Teaching Fellowship Scheme nominee’ must be completed by a senior representative of the nominating institution.

NTFS Individual 2010

Application Form

Nominee details

First name		Surname
Other name		Title
Job title
Department
Institution
Eligibility of Institution	Please click here to confirm your institution is eligible for the scheme
Address	Postcode:
Work tel.
Work fax
Email
Mobile
Alternative email (if not at work for results)

2. Assessment Categories

The Academy will endeavour to allocate an independent peer reviewer with appropriate expertise to assess your nomination. Applicants should note that this allocation will be based on the general level of specialism identified in the following categories and descriptors.

The discipline-related categories match the Higher Education Academy’s 24 Subject Centres. Please visit the Subject Centre websites to identify the most appropriate subject category (dropdown list of 24 Subject Centres, available on the Academy’s homepage www.heacademy.ac.uk. The categories are listed in alphabetical order.

Please choose up to three categories and rank your selected categories according to their level of relevance (1 = most relevant):

Art, Design & Media		Information and Computer Sciences
Bioscience		Languages, Linguistics and Area Studies
Built Environment		Law
Business, Management, Accountancy and Finance		Learning Support and Technologies
Dance, Drama and Music		Materials
Economics		Mathematics, Statistics & Operational Research
Education		Medicine, Dentistry and Veterinary Medicine
Engineering		Philosophical and Religious Studies
English		Physical Sciences
Geography, Earth and Environmental Sciences		Psychology
Health Sciences and Practice		Sociology, Anthropology and Politics
History, Classics and Archaeology		Social Policy and Social Work
Hospitality, Leisure, Sport and Tourism		Staff and Organisational Development

To assist the allocation of an independent peer reviewer, please give a more specific description of the assessment categories you have chosen here.

For example, ‘Librarianship’ rather than ‘Learning Support and Technologies’, ‘Music’, rather than ‘Dance, Drama and Music’, or ‘Midwifery’ or ‘Pharmacy’ rather than ‘Health Sciences and Practice’.

3. Publicity consent

It is the responsibility of the individual applicant to inform and gain the consent of any third party contributing information (e.g. quotes, comments) to an application in order that the information given may be used in publicity. Please inform the NTFS Project Officer as soon as possible (ntfsindividual@heacademy.ac.uk) if there are changes to the information provided below.

Typical publicity will include press releases to national, local and institutional press offices; listing and articles on National Teaching Fellowship Scheme website; commemorative brochure; poster-boards and slideshow for awards ceremony; and general promotional material for the scheme.

Name and professional title as it should appear on all publicity including the certificate

Job title

Institution

If successful in my application for a National Teaching Fellowship, I agree to the information contained above and in my full application for NT Fellowship* and that contained in the personal profile** being used for publicity purposes.

* Full application for NT Fellowship comprises the following (see section 16 and 17 of the ‘NTFS Individual 2010 Awards Guidelines’):

A signed statement of support from the institution’s senior manager (max. of 2 A4 pages);
Claim for NT Fellowship: a statement of how the individual demonstrates excellence relevant to each of the three headline individual award criteria (maximum 5,000 words);
A brief curriculum vitae (maximum of three A4 pages).

** The personal profile is a required component for a complete submission to NTFS (see section 21 of the awards guidelines).

If successful in my application for a National Teaching Fellowship, I agree to a photograph* of myself being included in the following:

National Teaching Fellowship Scheme 2010 awards dinner publicity materials and brochure;
General Higher Education Academy publications and website;
Sent to national and local press offices in response to requests for a photograph of the winner.

* Photographs must be provided by nominees with their personal profile submission (see section 21 of the awards guidelines)

Signed

Print Name

Date

4. Affirmation of institutional support for a National Teaching Fellowship Scheme nominee

The purpose of this form is to gather an explicit pledge from a senior representative of the nominating institution regarding the support the institution will give the nominee if a National Teaching Fellowship is awarded.

I affirm that, should the nominee be awarded a National Teaching Fellowship, the institution will: fully support the nominee in the conduct of any and all activities associated with the role of National Teaching Fellowship holder acknowledge that the NT Fellowship holder is responsible for determining how the funds are spent, in consultation with the relevant institutional department i.e. Finance/Accounting administer the award funds on behalf of the NT Fellowship holder without any administration, overhead or other charge, and without substitution of any kind for other funding.
Signed
Print name
Position
Date

In order to contact you to inform you of the outcome of the nomination process please could you complete your contact details below.

Contact Address

Post code:

Work Telephone

5. Data Protection Act Statements

To effectively administer the scheme, the Academy requests your permission to store the details supplied on this form, and the nomination documentation, in both paper and electronic format.

The Academy is not subject to the provisions of the Freedom of Information Act. However, we are committed to meeting its standards of openness and accountability and aim to deal with requests for information in the spirit of the Act, as far as is reasonable and practical. You can view the Academy’s policy online at http://www.heacademy.ac.uk/aboutus/governance/policies_and_procedures.

The nomination documents will be distributed to external peer reviewers as well as to members of the Advisory Panel as part of the assessment process. We withhold the right to release information contained within the nomination documents to inform future review processes and evaluation activities. Contact details will not be shared with any third parties unless you indicate your agreement to the statements on the following page (p.5).

I agree to the information on this form being shared with the Higher Education Academy and its Subject Network.
I agree to the information on this form being shared with my own employer for the purposes of networking and professional development.
I would like to receive further information about the Higher Education Academy and agree to the details on this form being stored on the Academy’s database for mailing purposes.
I agree to the information on this form being stored in paper and electronic format for use by the Higher Education Academy and its Subject Network and any of the statements indicated above.
Signed
Print name
Date

6. Compliments and Complaints

We aim to set, maintain and deliver high standards of service to all our stakeholders. Compliments are always welcome and can be made informally - either direct to particular members of staff concerned or to the relevant manager or more formally through our compliments and complaints policy. Despite our best efforts, there may be occasions when you feel that you have not received appropriate levels of service and have cause to complain. We would encourage you to contact us by telephone or email in the first instance to see if we can resolve the matter. View the Academy's compliments and complaints policy.

7. Submission and receipt of nominations

This application form, along with the three documents that comprise the nomination (see section 16 and 17 of the ‘NTFS Individual 2010 Awards Guidelines’), must be received electronically, as four 'Word' documents, by 12 noon on Wednesday 3 February 2010 to ntfsindividual@heacademy.ac.uk, with the subject heading ‘Nomination for National Teaching Fellowship Scheme’.

Receipt of electronic nominations will be acknowledged by email to the individual that submitted the application. Please note that nominations will be manually checked to ensure they meet formatting requirements before acknowledgement is sent. Electronic signatures are not required on electronic submissions. If the individual submitting the nomination does not receive an email within 48 hours of submission, they should contact the NTFS team at ntfsindividual@heacademy.ac.uk (Tel: 01904 717500).

Hard copies of the core nomination documents, including signatures, must be received by the Academy by 12:00 noon on Friday 5 February 2010. No additional material will be accepted. Hard copy documents should be addressed to:

Project Officer (NTFS Individual)

The Higher Education Academy

Innovation Way

York Science Park

Heslington

York

YO10 5BR