8/18/2019 PM2015 Student Nomination Form
1/2
315548097.doc/15 December 2010Registered Charity Number 210
566VAT Registration Number 232 351 891
66 Portand Pa!e
"ondon #1$ 1A% &'
Te ()) *0+20 ,580 5533
-a. ()) *0+20 ,255 15)1
in/oribaorgar!hite!ture!om
Pubi! n/ormation ine
0906 302 0)004
4!a !harged at 50 er minute
Registered Charity Number 210 566
VAT Registration Number 232 351 891
President’s Medals Student Awards 2015tudent Nomination -orm
Pease !omete ALL se!tions in this /orm by tying inside the
bo.es 7n!e ase!tions are !ometed sae this /orm together ith the
Tutor n/ormation -orm anda materias /or your entry *design ro:e!t
or dissertation+ on a C%;%V% or &$ drieto be submitted /or this
yearr >s et!+
Student’s first name Student’s surname
Student’s email address This must be aid at least until
!une 201"# nstead o/ your a!ademi! emaiaddress ease use a eb?based
emai address *su!h as yahoo or hotmai+ toensure that e !an !onta!t
you ith the resuts o/ the :udging ane
Student’s tele$hone number A mobie;!e number is
re/erabe to ensure that e !an !onta!t you ith theresuts o/ the
:udging ane
Student’s $ostal address
Address
City
Post!ode
Country
Student’s nationalit%
S&hool of ar&hite&ture*this is the s!hoo here you
are enroed in the most re!ent a!ademi! year+
'ourse*this is the !ourse in hi!h you are enroed in the most
re!enty !ometeda!ademi! year@ eg $A Ar!hite!ture+
This is a ()A Part 1 !ourse This is a ()A Part
2 !ourse
8/18/2019 PM2015 Student Nomination Form
2/2315548097.doc/15 December 2010Registered Charity Number 210
566
VAT Registration Number 232 351 891
66 Portand Pa!e
"ondon #1$ 1A% &'
Te ()) *0+20 ,580 5533
-a. ()) *0+20 ,255 15)1
in/oribaorgar!hite!ture!om
Pubi! n/ormation ine
0906 302 0)004
4!a !harged at 50 er minute
Registered Charity Number 210 566
VAT Registration Number 232 351 891
*our nomination
am submittin+*ease ti! one o/ the !ategories+B
7ne %esign Pro:e!t /or the )ron,e Medal ; R$A Part 1
!ategory
7ne %esign Pro:e!t /or the Sil-er Medal ; R$A Part 2
!ategory
7ne %issertation /or the .issertation Medal ritten
during R$A Part 1
7ne %issertation /or the .issertation Medal ritten
during R$A Part 2
.esi+n Pro/e&t .issertation Title
Student’s Statement *ease tye a statement o/ u to 200 ords
about your entry in the bo. beo This
te.t i be submitted /or the !onsideration o/ the :udges and i be
used in ubi!!ommuni!ation at/orms su!h as the aards ebsite ress
reeases e.hibitionanes et! As su!h e re!ommend that you rite this
statement as a !on!ise and!ear des!rition o/ your ro:e!t Pease
ensure that you use the ord !ount too toedit your te.t as ie!es
onger than 200 ords i NOT be a!!eted+
