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 election of five (5) Members of the Convocation Executive Committee as contemplated in clause 17.3.5 of the Convocation Constitution
DETAILS OF NOMINEE
SURNAME:
STAFF NUMBER:
COMPANY/ORGANISATION:
CONTACT DETAILS:
DETAILS OF NOMINATOR
SURNAME:
STAFF
COMPANY/ORGANISATION:
CONTACT DETAILS:
Email address Address
Declaration by the Nominator:
As Nominator 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 eligibility criteria for nomination and election of Five (5) members of the Convocation Executive Committee as per Clause 17 3.5 of the CPUT Convocation Constitution.
• I acknowledge that all 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 election of Five (5) members of the Convocation Executive Committee 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 eligibility criteria for nomination and election of Five (5) members of the Convocation Executive Committee as per Clause 17.3.5 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 election of Five (5) members of the Convocation Executive Committee 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 a member of the Convocation Executive Committee. I hereby, accept the nomination and confirm my willingness to serve and fulfill the duties as a member of the Convocation Executive Committee should I be elected to that position. I have read and understand the information contained in the CPUT Convocation Constitution, particularly Clauses 17,18 and 19 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 of members of the Convocation Executive Committee 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 election to the office of the member of the Convocation Executive Committee.
4. I have obtained my first qualification at the CPUT/PENTECH or CAPE TECH at least five (5) years before the nomination date.
5. I am not an Employee nor Academic Employee nor Student of 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