STEM Champion Award – Supporting Reference 

 

 

Celebrating individuals who are contributing to the success of Aboriginal and Torres 
Strait Islander students in achieving their STEM aspirations 

 

To be eligible for this award, applicants and referees must be able to show how the applicant has 
contributed to the implementation of an Indigenous STEM Education program. 

• Applicants are encouraged to submit at least one reference to support the nomination. 
• Applicants must include a statement from a supporting community representative, teacher, school, 
student and/or other program staff that: 
o Describes how the applicant is contributing to the success of Aboriginal and Torres Strait 
Islander students in achieving their STEM aspirations. 





 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
INDIGENOUS STEM AWARDS 

 




Referee Privacy Statement

Use of personal and sensitive information provided by the referee 

Your personal information is protected by the Privacy Act 1988 (Cth) and CSIRO will handle your personal 
information in accordance with this Act. 

CSIRO is collecting your personal information, including your name, contact details and any responses to 
questions you provide as a referee of an applicant for the Indigenous STEM Awards. 

CSIRO will also collect your personal and sensitive information from your profile photo, any video responses 
and school report/results for this purpose. 

CSIRO will treat all personal information collected as part of your support for the applicant in accordance 
with CSIRO Privacy Policy, and use it specifically in relation to the Indigenous STEM Awards program. 

The CSIRO Privacy Policy available at https://www.csiro.au/en/About/Access-to-
information/Privacy outlines how your personal information will be handled, including details about how 
you can seek access or correction of the personal information we hold about you and how you can 
complain about a breach of the APPs and how CSIRO will deal with the complaint. If you require further 
information on how your personal information will be handled, please contact privacy@csiro.au.

Do you (the referee) consent to the collection and use of your personal information as set out in this 
privacy statement? 

Yes 

No 

Referee Details 



First Name: Last Name: 

Contact Phone: Email: 

Relationship to Applicant: 
































Response 

1. Please describe the support provided by the applicant and the impact it has had on the aspirations of 
Aboriginal and Torres Strait Islander students. 

(eg. the students have an increased level of engagement in classroom, student improvement in science and/or maths 
marks, STEM aspirations) 

Click here to enter text up to 550 words. 

 

P70TB2#y1

2. (Optional) Please add any other information that may be relevant to this application. 

Click here to enter text up to 550 words. 

 

P71TB1#y1