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Fellows Application Form

Careers
Fellows
Application Form

Fellows Application Form

Nominate self

Nominate other

Nominator

First Name*

Last Name*

Email*

Award

Nominee Personal Details

Title

First Name

Last name

Address1

Address2

City

Postcode

Phone

References

Please give the names and contact details (including email addresses) of three Fellows of the Institute who are willing to act as referees:

Referee One

Title

First Name*

Last name*

Referee Two

Title

First Name*

Last name*

Referee Three

Title

First Name*

Last name*

In being elected to the Fellowship, I agree to uphold the NZIC Rules and Code of Ethics*

Supporting Document

Your supporting document should include a written statement (1-2 pages) about your involvement with the NZIC as well as your CV.

Upload Supporting Files

Files You Selected:

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Nominator

First Name*

Last Name*

Email*

Award

Nominee Personal Details

Title

First Name

Last name

Address1

Address2

City

Postcode

Phone

References

Please give the names and contact details (including email addresses) of three Fellows of the Institute who are willing to act as referees:

Referee One

Title

First Name*

Last name*

Referee Two

Title

First Name*

Last name*

Referee Three

Title

First Name*

Last name*

Supporting Document

Your supporting document should include a written statement (1-2 pages) about your involvement with the NZIC as well as your CV.

Upload Supporting Files

Files You Selected:

No Files Selected

Contacts

Samantha Eason
Administrator

Email: admin@nzic.org.nz

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Member Organisations

NZIC is a member of the
Royal Society Te Apārangi

and of
Commonwealth Chemistry

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