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2024 LSQ MCCULLOUGH ROBERTSON INDUSTRY EXCELLENCE AWARD – Nomination Form

Nominations close at midnight on 30 June 2024.

NOMINEE INFORMATION

(Professor/Dr/Ms/Mr etc)*

First Name*

Last Name*

Organisation*

Position*

Phone number*

Email*

NOMINATOR INFORMATION
Leave blank if you are nominating yourself. Otherwise, please complete all fields.

Personal Title (Professor/Dr/Ms/Mr etc)

Nominator First Name

Nominator Last Name

Nominator Organisation

Nominator Position

Nominator Phone

Nominator Email

ELIGIBILITY CRITERIA

Award nominees must:

be in the mid to late stages of their career
work for an LSQ member organisation in any area of the life sciences
not have won this award in the past five years
not have served on the LSQ Board of Directors in the past three years.

AWARD JUDGING CRITERIA

Judges are seeking an individual who has made a significant impact on the success of the Queensland life sciences industry.

Your submission should provide evidence to show you (or your nominee) has:

made contributions that enhance the Queensland life sciences industry beyond your current role
demonstrated leadership by inspiring and empowering others
implementing innovation and creativity in the life sciences industry
helped raise Queensland's profile and capabilities.

Please tell us why you (or your nominee) should receive the Industry Excellence Award*

Provide a maximum of 250 words, ensuring you address the Award Judging Criteria above.

CV*

Please provide a 2pp (max) CV as a PDF to support your application.

Nominee Headshot*

Please provide a high-quality portrait as a jpg or png. Note this will be used in all award publicity and media communications.

Letter of Support as PDF (optional)

Applicants are encouraged to provide letters of support from external parties to strengthen their entry. Please attach these as PDFs.