NOMINATION FORM: MEMBERS OF THE CONVOCATION EXECUTIVE COMMITTEE
Nomination by eligible members of the Convocation as defined in clauses 69.1 and 69.2 of the CPUT Statute for the designation of two (2) full-time Academic Employees as contemplated in clause 17.3.4 of the Convocation Constitution
DETAILS OF NOMINEE
SURNAME:
STAFF
COMPANY/ORGANISATION:
CONTACT DETAILS:
Email address
Address
Cell Number
DETAILS OF NOMINATOR
SURNAME:
STAFF
COMPANY/ORGANISATION:
CONTACT DETAILS:
Email address
Address
Cell Number
Declaration by the Nominator:
As Nominator and by signing this form, I declare the following:
• I am a member of the Convocation contemplated in Clause 69 (1) read with 69 (2) of the CPUT Statute.
• I have read and understand the criteria for nomination and designation of two (2) full time Academic Employees of the Convocation as per Clause 17.3.4 of the CPUT Convocation Constitution.
• I acknowledge that all the information, including personal information of the Nominee provided is correct and that I have the necessary permission and consent from the Nominee to provide CPUT with the aforesaid information.
• I acknowledge that all my information provided is correct and give permission that my personal information may be processed by CPUT, Operator and relevant employees for the purpose of nomination and designation of two (2) full-time Academic Employees of the Convocation and processes related thereto.
Signature of Nominator:
Date:
Seconders:
Declaration by Seconders:
As Seconder, and by signing this form, I declare the following:
• I am a member of the Convocation, as contemplated in Clause 69 (1) read with 69 (2) of the CPUT Statute.
• I have read and understand the criteria for nomination and designation of two (2) full time Academic Employees of the Convocation as per Clause 17.3.4 of the CPUT Convocation Constitution.
• I acknowledge that all my information provided is correct and give permission that my personal information may be processed by CPUT, Operator and relevant employees for the purpose of nomination and designation of two (2) full-time Academic Employees of the Convocation and processes related thereto.
Details of Seconders (Please provide full first names and surname):
Seconder 1:
Seconder 2:
ACCEPTANCE AND UNDERTAKING BY NOMINEE
I, the undersigned, confirm that I am eligible to be nominated as the Convocation Executive member contemplated in clause 17.3.4 of the Convocation Constitution (full time Academic Employees) I hereby accept the nomination and confirm my willingness to serve and fulfill the duties as the full-time Academic Employees of the Convocation should I be designated in that position. I have read and understand the information contained in the CPUT Convocation Constitution, particularly Clauses 17 and 18 thereof.
Full Name(s) & Surname:
ID Number:
Date and Place:
Signature:
Staff Number:
Vision Statement by the Nominee in support of the nomination: (May be attached as a separate document):
Declaration by the Nominee:
1. I acknowledge that all the information provided is correct.
2. I authorise and consent to the submission of the information, including my personal information to CPUT, Operator and relevant employees to collate, collect, process, store, use and disclosure of such information for the purpose of nomination and designation of two (2) full-time Academic Employees of the Convocation and processes related thereto.
3. I am a member of the CPUT Convocation as contemplated in clause 69 (1) read with 69 (2) of the CPUT Statute, and eligible for designation to the office of the full time Academic Employees of the Convocation.
4. I am a full-time academic employee at the University.
Signature of Nominee
Date:
Please submit duly completed nomination forms, and written motivations supporting the nomination to: ConvoElect@cput.ac.za on or before Saturday, 19 July 2025