Curtin Extra - Nomination - 2024

CONTACT INFORMATION

First Name

MI

Last Name

Email

PROGRAM INFORMATION

Note: you can save this form as a draft by completing as required fields with some text (e.g. n/a). You can return to edit any time.

Program name

Program description

Provide a brief overview of the program (history, purpose, aim). This section may be displayed on the Curtin Extra website.

Program location

Timeframe

Recruitment process

How do you recruit students to participate in this program (e.g., EOIs, applications, interviews)?

Student Targets

Is this program available to all Curtin students or specific cohorts? Eg faculty based, course, location, year of study, relevant experience? How many students do you anticipate participating in this program?

Eligible Student cohorts

which student cohorts can participate in the program?

Program structure

Describe the structure of events and activities over the course of the semester or year.

UN Sustainable Development Goals

Please select which UN SDG is being addressed (if any)

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Training requirements

Does this program involve mandatory training to adequately prepare students to undertake the tasks? If training is not applicable, please elaborate.

Additional information

Include any other important information about the program and any other program requirements not listed above.

Learning outcomes

How does the program help students to develop their Curtin Graduate Capabilities?

Graduate Capabilities developed

Curtin Extra stream

Select one

Curtin Extra tier (select one)

Students must complete these requirements within 12 months. There are two rolling participation periods: 1 December to 30 November and 1 July to 30 June.

STUDENT PARTICIPATION POSITIONS

Select the position(s) that students can actively participate in and describe the activities and responsibilities in the position description. Exclude activities linked to: academic credit, social events, any other Curtin Extra program (no double dipping), travel time

Commitee Member

Mentor

Office Bearer

Participant

e.g., active participant in workshops, board meetings, group work, mentee sessions (by industry or alumni)

Student Consultative Committee

e.g., student voice activities, facilitate peer consultations, panel member at events.

Student Representative

Team Leader

Tutor

Volunteer

Work Experience (Paid)

Other

e.g., program specific roles

STUDENT PARTICIPATION HOURS

Expected hours of student participation

Estimate the number of hours you expect students to actively participate in this program, based on fulfilling the selected roles above.

Verification method

How will you verify the participation hours logged by students? eg check to attendance lists, meeting minutes, program databases/software. You will be required to store these records for audit purposes.

Any additional information

Documents for upload

CURTIN EXTRA POLICY CONSIDERATIONS

Confirmation of program eligibility

All activities are co-curricular in nature and not linked to academic credit Program provides a minimum of 20 hours of active participation Training will be provided to sufficiently prepare participants to undertake tasks (if applicable) Program is coordinated, monitored and supervised by the program coordinator (Curtin staff) who can verify the hours and activities undertaken Student outcomes are aligned to the Curtin Graduate Capabilities No double dipping of hours between Curtin Extra programs

Additional information

Please provide details if you are unable to tick any of the boxes above.

Have you completed a Risk Assessment for this program?

CONTACT DETAILS

Program Coordinator - First Name

The program coordinator must be a Curtin staff member

Program Coordinator - Last name

Staff ID

Staff email

(e.g., 123456a@curtin.edu.au)

Telephone

Program email

Program group email inbox (not personal)

Program website (if available)

Curtin Faculty/ Department

HEAD OF AREA

The Head of Area is usually the Director, Student Engagement for the faculty, or equivalent. This person is responsible for the overall quality of the program and the OH&S Risk Assessment.

First Name

Last Name

Job Title

Staff email

OFFICE USE ONLY

To be completed by the Curtin Extra Team

HOA authorisation

Authorisation date

Evidence held

Curtin Extra - nomination outcome

Approval Conditions

Curtin Extra Approval Date

Curtin Extra Expiry Date