CRICOS PROVIDER CODE 00099F

OFFICE USE ONLY

Application Number

UTS Course code Receipt number

INTERNATIONAL STUDENT APPLICATION FOR HIGHER DEGREE BY RESEARCH UNIVERSITY OF TECHNOLOGY SYDNEY

1. COURSE PREFERENCE

UTS course code UTS course name

UTS course code UTS course name

When do you wish to begin your studies? £ Between 1 January – 31 March £ Between 1 July – 31 August Year

2. PERSONAL DETAILS (as shown on your passport)

Family name

Given name

Date of Birth ££ /££ /££££ Sex £ Male £ Female £ X (Indeterminate/Intersex/Unspecified

Your address in your home country

Postcode/Zip

TelCountry code Area code Number

MobileCountry code Area code Number

Fax Country code Area code Number

Email You must provide your email address

Your address for correspondence (or UTS representative company stamp)

Postcode/Zip

TelCountry code Area code Number

MobileCountry code Area code Number

Fax Country code Area code Number

Email You must provide your email address (or UTS representative email address)

Print S in the appropriate boxes.

3. VISA DETAILS

Nationality Country of Birth

Country of Permanent Residency Passport Number

Do you hold citizenship or permanent residency in a country/countries other than what you have listed in your application form?

£ No £ Yes ÆIf YES, which country/countries?

Are you already in Australia? £ No £ Yes Æ

Visa category

Visa expiry date (Date/Month/Year)

££ /££ /££££ Year of entry into Australia

££££If you hold a visa with a category other than 'student', you must include a certified copy of your visa with your application.

4. ENGLISH LANGUAGE PROFICIENCY

Is English your first language? £ No £ Yes If no, what is your first language?

Have you already studied in English?Note: Please provide a certified copy letter from your institution.

£ No £ Yes Æ At what level?

Have you taken an English Test?Note: Please provide a certified copy of your English proficiency test.

£ No £ Yes ÆName of test Date of test

££ /££ /££Place Test score

6. RESEARCH SUPERVISOR

Research applicants MUST have made contact with a potential supervisor. Has a potential supervisor agreed to supervise you?

£ No £ Yes Æ

If yes, name of UTS Supervisor

If NO, refer to: Find a supervisor http://cfsites1.uts.edu.au/find/uts-research/find-a-supervisor/index.cfm and email the appropriate faculty research staff member BEFORE submitting this application. Note: A potential supervisors’ agreement to supervise you does NOT constitute acceptance into a UTS research degree. You must submit an application and meet the academic and English language entry requirements.

7. RESEARCH PROPOSAL AND THESIS TITLEProvide a detailed research proposal as a separate document. Refer to the information on how to develop your proposal: http://www.uts.edu.au/research-and-teaching/future-researchers/research-degrees-uts/develop-your-research-proposal

Thesis title

5. EDUCATION DETAILS

Tertiary studies – list all the courses you have enrolled in. If you have not completed your degree yet please write the intended year of completion.

Course Institution and Country/State Duration (number of years) Date awarded / completed

££ /££ /££Course Institution and Country/State Duration (number of years) Date awarded / completed

££ /££ /££Course Institution and Country/State Duration (number of years) Date awarded / completed

££ /££ /££Have you ever been excluded (or are you facing exclusion) from a course on academic or other grounds?

£ No £ Yes ÆAttach details on a separate sheet. Please attach the details of your exclusion to this application form.

Are you currently enrolled in an Australian institution? £ No £ Yes Æ

If yes, provide name of Institution

Note: If you are currently studying a master’s (research) or a PhD at another Australian institution and would like to transfer your studies to UTS, you MUST provide an enrolment letter from your current institution which indicates the EFTSL (duration of study) completed to date.

3. VISA DETAILS (CONTINUED)

Are you currently enrolled in an Australian institution? £ No £ Yes Æ

Name of institution

Are you currently studying at UTS? £ No £ Yes ÆStudent number

Do you have Overseas Student Health Cover? (OSHC) £ No £ Yes ÆProvider Membership number

Are you in the process of applying for permanent residency in Australia? £ No £ Yes

8. CV/RESUMEProvide a detailed CV/resume which outlines your tertiary qualifications, professional experience and research experience as a separate document. Please provide evidence of any claims you make in your CV. Give details of your professional experience, how it relates to research, level of responsibility and dates of employment.

13. DISABILITY DETAILS

Do you have a disability or ongoing medical condition that will require you to seek special assistance from the university?

£ No £ Yes ÆDescription of disability

If yes, please attach a medical statement from a registered doctor.

11. ACADEMIC REFEREES

You must provide details of two academic referees who are familiar with your studies and are qualified to comment on your previous academic achievements and your capacity to undertake a research program.

Referee 1 Mr £    Mrs £     Ms £  Other Referee 2 Mr £    Mrs £     Ms £  Other

Full name Full name

Position Position

Institution/company Institution/company

Email address Email address

Contact telephoneCountry code Area code Number

Contact telephoneCountry code Area code Number

12. SCHOLARSHIP/SPONSORSHIP INFORMATION

Do you already have a sponsor/scholarship from an organisation or government? £ No £ Yes

If no, you will be required to cover the tuition fee and living expenses for the duration of your degree.If yes, please attach a copy of the letter of guarantee documents from your sponsor if available and complete the following:

Sponsor/scholarship name

Sponsor mailing address

Sponsor contact person Sponsor telephone

Sponsor email Sponsor fax

Do you wish to be considered for an International Postgraduate Research Scholarship (IPRS)? £ No £ Yes

IPRS applicants will also be considered for the Australian Postgraduate Award (APA) which covers living allowance and the UTS International Research Scholarships (IRS) which covers tuition fees.Closing dates for IPRSIf you wish to be considered for an IPRS, APA or IRS you must submit this application by 20 August (for commencement in the following year) For more information about IPRS, including eligibility criteria and conditions for award, please visit: https://www.uts.edu.au/research-and-teaching/future-researchers/research-degrees-uts/research-scholarships/international

10. PRIZES

Provide details of any prizes which you have been awarded on a separate document. Please provide the details in the required standard format as indicated in the How to apply section. If your prize is not in English please provide a certified English translation.

9. PUBLICATIONSProvide details and evidence of your scholarly publications which you have authored using a standard referencing system. If your publication is not in English please provide a certified English translation of the title. Guidance on how to format publication references is provided in the web link below: http://www.lib.uts.edu.au/help/referencing/harvard-uts-referencing-guide

UTS:MCU / JOB 19437 / JUNE 2015

15. DECLARATION AND SIGNATURE

Please sign and return the following declaration. This application form MUST be signed by the applicant.

I agree 1. To abide by the rules of

admission, enrolment and progression of UTS.

I declare 1. All the information and

supporting documents provided with this application are true and correct and I will inform UTS immediately of any changes to the information I have given;

2. I have accessed sufficient information to understand the structure and content of this course;

3. I have access to sufficient funds to cover Tuition Fee payments, living expenses and other related expenses incurred by me and my dependants during my enrolment at UTS;

4. I have not previously had an Australian visa cancelled or an Australian visa application rejected; and

5. That I have personally signed this form.

I understand 1. That UTS may obtain official records from any institution I have previously attended;2. That all documents submitted with this application become the property of UTS;3. That in order to be admitted to the University I must meet the academic and English language requirements set

by UTS and the Genuine Temporary Entrant (GTE) and Genuine Student (GS) criteria set by the Department of Immigration & Border Protection (DIBP). For information about the GTE and GS criteria please visit www.immi.gov.au/students/gte-requirement.htm

4. UTS reserves the right to cancel my offer and acceptance if it is not satisfied that I meet the GTE and GS requirements set by DIBP;

5. The expenses (tuition fees, living expenses and other expenses) related to the study of this course/s at UTS.6. Tuition Fees and the Student Services and Amenities Fee (SSAF) increase from year to year, and I accept that it is

my responsibility to pay the increased fees as required;7. I am fully responsible for payment of my educational and living expenses and any other associated expenses while

I am enrolled at UTS;8. UTS will not be responsible for any Tuition Fee payments, living expenses or other related expenses incurred by

me during my enrolment at UTS;9. In the event that false, inaccurate and/or misleading information is provided to UTS, UTS reserves the right to

cancel my application and/or enrolment at any time;10. If I fail to pay my Tuition Fees, UTS will cancel my enrolment;11. If I intend to bring school-aged dependants to Australia, I will be required to pay full fees if they are enrolled in

either a government school or non-government school;12. The personal information collected on this form and during my enrolment at UTS may be disclosed to the

Australian Government and designated authorities where required for compliance with the Education Services for Overseas Students Act 2000 (Cth) and associated legislation with which UTS must comply;

13. While on a student visa I am required to inform UTS of any change to my residential address, mobile telephone number, or email address within 7 days; and

14. If I am or become personally prohibited under any Federal legislation or regulation from commencing or continuing my enrolment in the above course at UTS or any part of that course, UTS reserves the right to withdraw this offer and/or cancel my enrolment in the course or relevant part of that course.

Your signature Date (day/month/year)

££ /££ /££££We advise that you keep a copy of your application and all attachments for your records.

16. SEND APPLICATIONS TOThe Graduate Research School University of Technology Sydney PO Box 123 Broadway NSW 2007 AUSTRALIATel: +61 2 9514 1336 Fax: +61 2 9514 1588Application enquiries: international.research@uts.edu.au Web: http://www.uts.edu.au/research-and-teaching/future-researchersUTS will acknowledge receipt of your application by email.

Note> Admission to courses at UTS is competitive> This application is not an enrolment form, and does not

guarantee admission> There is no charge for this form

Certified Copies of Supporting DocumentationUTS will only accept copies certified by employees from specificorganisations. Go to Step 5 of the ‘Applying at UTS” webpage for moreinformation: https://www.uts.edu.au/research-and-teaching/future-researchers/research-degrees-uts/applying-research-degree-and

CLOSING DATES FOR APPLICATIONS30 September (January – March commencement)31 March (July – August commencement)

AN INCOMPLETE APPLICATION WILL DELAY PROCESSING. LATE APPLICATIONS MAY NOT BE ACCEPTED.

14. CHECKLIST – HAVE YOU

£ Completed all sections of this application £ Provided professional experience reference letters (if applicable)

£  Enclosed certified copies of all your academic qualifications £ Provided research proposal

£ Enclosed CV/resume £  Provided name and contact details of two academic referees (if applicable)

£ Provided details of your publications (if applicable) £ Provided sponsorship documents (if applicable)

£ Provided details of your prizes/awards (if applicable) £ Provided a certified copy of your English proficiency test (if available)

Note: An incomplete application where documents are missing will delay processing.