COT Nomination Form - Word

50 Inspiring Years, 50 Exemplary Stories
COLOURS OF TARCIAN (COT)
Project Overview
TARCian Alumni Association (TAA) has a vision of “Solidarity in the service of
our community” i.e. creating and promoting a sense of belonging as well as unity,
solidarity, integration, goodwill and mutual cooperation amongst TARCIANs. It is
with this vision that we embark on this project aptly titled “Colours of TARCian”. “
Colours of TARCian” best describe the Variety of Colours of TARCIANs who
have served and is serving the community. Even though we come from different
ethnic groups, religious background and political stand, we are united in our
stand to create a moderate, harmonious and friendly community. We hope that
our unique ‘colours’ would bring much brightness to our relationship and add
more meaning to the lives of all Malaysians, particularly the ideals, tradition and
good name of our Alma Mater.
“Colours of TARCian” is a project depicting a series of alumni success stories to
showcase the contribution of TARCians to the society and to inspire the young
from all walks of life. It will serve as a testimonial and portfolio for all TARCians,
promoting a sense of pride in all TARCians. In conjunction with TAR UC
celebrating its 50th Anniversary, 50 TARCian success stories from all walks of life
will be featured in a coffee table book which will inspire students, parents and
alumni. It will feature bilanguage write-ups (Chinese & English) and 3-5 minute
video clip for each story. The stories will be uploaded on TAR UC and TAA
website.
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
“Colours of TARCian ” Nominations are now open. Please complete the form
below to nominate a TAR UC alumna or alumnus. The nomination deadline is 30
SEPTEMBER 2016. Only completed nominations received by the due date will
be considered. Supporting documents should be submitted via emailing or post
mailing. Please note that the strongest nominations include detailed responses
and an additional letter of support as well as supporting material (eg. Awards
Certificates, Newspaper Cutting etc), a resume or CV. Any enquiry please
contact the following persons:
Secretariat Office. Ms Yock Lian. 012-316 8306 ([email protected])
COT Nomination Chair - Mr KC Teo.
COT Project Chair - Ms Jade Lim. 012-317 0886 ([email protected])
Colours of TARCian (COT) Nomination Form
Nomination Guideline

Be an alumni of TAR UC (TAR College);

Be of excellent reputation and a source of inspiration and encouragement to
others, especially the next generation of leaders;

Have accomplishments and contributions that have a great impact in their
organization, industry and the community at large;

Have exemplary leadership with outstanding and enduring contributions to
the improvement of products, processes, technology or human relations in
business or in the community;

Have made significant contributions to the community;

Have not committed a crime and / or a bankrupt;

The application must be typed;
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories

If additional space is required for any section of this application, please
submit on a separate, clearly labeled sheet along with this form;

ONLY Selected nominees will be notified;

Incomplete application or false information negates the application.
SECTION 1 CATEGORY
Please tick on the category which nominee belong to
1.
Government / Politician
2.
Educationist / Academician
3.
Science / Technology & invention
4.
Business / Entrepreneurship
5.
Literature / Journalism
6.
Entertainment / Journalism
7.
Sports
8.
NGO / Humanities / Community Services
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
SECTION 2 NOMINEE INFORMATION
1)
Please describe your nominee’s exceptional professional achievements and
contributions or Service, (required)
2)
What other attributes has your nominee demonstrated that qualify her/him to
be honored? (Required)
3)
Please describe the impact of your nominee on a local, regional, national,
and/or international level. (optional)
4)
Is there anything else about your nominee that you would like the Selection
Committee to consider? (optional)
5)
Letters of support from individual who is able to validate the nominee’s
achievements. (optional)
Nominee Information
Name of Nominee: _____________________________________________________
Year Graduated in TAR UC: ______________________________________________
Course: _______________________________________________________________
Faculty: ________________________________________________________________
Company Name: ________________________________________________________
Company Address:
________________________________________________________________________
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
Telephone No: ______________________
Fax No: ____________________
Hand phone Number: __________________ Email Address: ___________________
Position: _______________________________________________________________
Nature of Business/ Profession:
________________________________________________________________________
________________________________________________________________________
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
1)
Please describe your nominee’s exceptional professional achievements and
contributions or Service. (Required)
Year
Achievement/ Contribution (be specific)
Personal Awards Received
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
2)
What other attributes has your nominee demonstrated that qualify her/him to
be honored? (Required)
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
3)
Please describe the impact of your nominee on a local, regional, national,
and/or international level. (optional)
4)
Is there anything else about your nominee that you would like the committee
to consider? (optional)
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
SECTION 3 NOMINEE DECLARATION
I hereby declare that the information given in this form is to the best of my
knowledge and in every respect true and correct. My personal data is given with
consent.
Nominee Signature:
Nominee IC Number: ________________________
Date: ____________________
SECTION 4 NOMINATOR INFORMATION
Name of Nominator: ____________________________________________________
Telephone No: ______________________
Fax No: ______________________
Hand phone Number: ________________Email Address: ______________________
Relationship with Nominee: ______________________________________________
How long have you known the nominee: ___________________________________
In what capacity: ________________________________________________________
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
In 300 words or less, please tell us why you think your nominee deserves to be
featured as an exemplary TARCian.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Nominator Signature:
Date: _________________
SECTION 5 SECONDER INFORMATION
Name of Seconder: ____________________________________________________
Telephone No: ______________________
Fax No: ______________________
Hand phone Number: ________________Email Address: ______________________
Relationship with Nominee: ______________________________________________
How long have you known the nominee: ___________________________________
In what capacity: ________________________________________________________
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
The nominator and seconder may be contacted for further information or
clarification.
Please tick to ensure that the nomination package includes the following:

Signed, completed nomination form including all contact information for the
nominee, nominator, seconder. Signatures are required before a nomination
form can be forwarded to the COT Committee.

ALL Required field to support Nominee’s exceptional professional
achievements and contributions or Service must be clearly written.

Emailing or post-mailing to TARCian Alumni Association necessary
supporting documents (eg. Copy of Awards Certificate, Newspaper cuttings,
CV etc) (Optional)
FORWARD NOMINATIONS TO:
By Mail:
By Email:
Colours of TARCian
(COT Project)
DEADLINE FOR
Room A008, Ground Floor,
Bangunan Tan Sri Khaw Kai
Boh, Tunku Abdul Rahman
NOMINATIONS
[email protected]
30 SEPTEMBER 2016
University College.
Jalan Genting Klang,
53300, Setapak,KL.
If you choose to post mailing to us, please ensure to send an email to inform about your
nomination. You will receive an email acknowledgment. If you don’t, please contact us.
We are here to ensure your nomination is well received for process.
THANK YOU FOR YOUR NOMINATION!
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my
50 Inspiring Years, 50 Exemplary Stories
FOR OFFICIAL USE ONLY:
Receipt Date:
Checked By:
Verified By:
Remarks:
TARCIAN ALUMNI ASSOCIATION
拉曼大学学院校友总会 (0351-12-WKL)
Room A008, Ground Floor, Bangunan Tan Sri Khaw Kai Boh, Tunku Abdul Rahman University College,
Jalan Genting Kelang, 53300 Setapak Kuala Lumpur, www.tarcalumni.my