alas 2012 application form

8/3/2019 ALAS 2012 Application Form

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2. Contact details

Residential address (Please check that your contact details are correct. If you cannot be

Address line 1*Address line 2

Address line 3

Town/City*

State/Province* Postal code (if

Country*

Contact details continued

Mailing address (Provide details only if this is different to your current residential

Address line 1

Address line 2

1. Personal details

Provide supporting documentary evidence of your full name, date of birth, gender andcountry of citizenship. For example, the identification page of your passport or otherofficial identification document issued by your country of citizenship.* Denotes mandatory field

Title* Mr Mrs Ms Miss DrOther(Please specify)

Family Enter your family name and other names asshown in your Birth Certificate, Passport orother official identification document. If youhave only one name, enter it in both fields.

Given*

Date of / / dd/mm/yyyy Gender* Male Female

Place ofbirth*

Ethnicgroup?

Country ofcitizenship*

You must be a citizen of one of the eligibleparticipating countries.

Do you have

dualcitizenship?* Yes No If you are a citizen of Cook Islands, Niue orTokelau and are entitled to hold a New Zealandpassport, please do not list New Zealand asyour first or second country of Citizenship.2nd country

of citizenship

Which country are you living in now?*

Have you applied, or are you intending toapply, for permanent residency or citizenship Yes No

NationalIdentity Provide if applicable to your country.*

Passport no.(provide ifyou have a

*

Issue date / /

Expiry date / /

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Address line 3

Town/City

State/Province Postal code (if

Country

Phone and email (Provide at least one contact number.)

Home phone no.* Work phone

Mobile no. Fax no. (if

Email 1

Email 2

3. Spouse details

If you have dependants (spouse and/or children under 18 years of age), provide their

details even if they will not accompany you to Australia. Note that the scholarshipdoes not provide financial support for accompanying dependants. You can getinformation on your responsibilities for your spouse and any dependant children,should they live with you in Australia during your scholarship, from the Department of

Family name Provide family name and other names asshown in your spouses birth certificate,passport or other official identificationGiven names

Date of birth / / dd/mm/yyyy Gend Male Female

Passport no.Provide if

Issue date / /

Expiry Date / /

Country ofcitizenship Will your spouse accompany you to Australia?* Yes No

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4. Children details (attach a separate list if there is not enough space)

Provide details of any dependent children and indicate if they will join you inAustralia.

A dependent child is the child or stepchild, of yourself or your spouse, who is notmarried or engaged to be married or in a de facto relationship and has not turned 18years of age.

NB: This Scholarship does not provide financial support for family membersaccompanying you to Australia.

Child 1 Will this child accompany you to Australia?* Yes No

Family name

Given names

Date of birth / / dd/mm/yyyy Gender Female

Country of

Passport no.Provide if child has

Issue date / /

Expiry date / /

Child 2 Will this child accompany you to Australia?* Yes No

Family name

Given names

Date of birth / / dd/mm/yyyy Gende Female

Country of

Passport no.

Provide if child has

Issue date / /

Expiry date / /

Child 3 Will this child accompany you to Australia?* Yes

Family name

Given names

Date of birth / / dd/mm/yyyy Gende Female

Country of

Passport no.

Provide if child has

Issue date / /

Expiry date / /

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5. Emergency contact details*

Provide details of a person that can be contacted in case of an emergency. This may

Title* Mr Mrs Ms Miss Dr

Other Please

Family name* Relationship toyou*

Given name* Gender* Male Female

Home phone* Work phone

Mobile phone Fax (if any)

Email 1

Email 2

Address line 1*

Address line 2

Address line 3

Town/City*

State/Province* Postal code (if

Country* Please check that the contact

6. Previous scholarships (attach a separate list if there is not enough space)

Only include details of post-secondary school scholarships or fellowships.

Have you previously been awarded a scholarship Yes No

1.

Start date End date Country

Qualification (if

Institution

2.

Start date End date

Qualification (if

Institution

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7. Scholarship applications

Applying for more than one scholarship does not make you ineligible to apply for an

What other scholarships are you currently applying for?

Have you previously applied for an AusAIDscholarship but were unsuccessful?*

Yes No

If Yes, in which years did you apply and were you interviewed? (max 500 characters,approx 100 words limit)

8. Proposed study*

AusAID will consider offering you a scholarship only if your course of study willcontribute to the long-term development needs of your country. A list of priorityfields is available from the AusAID office in your country or in the relevant country

profile on the AusAID website (http://www.ausaid.gov.au/scholar).AusAIDs website includes a full list of Australian Institutions that are eligible toreceive AusAID scholars. You need to decide which Institution you want to attend andchoose an appropriate course. To find out about the content of specific courses, youshould refer to the individual Institution websites.

You should choose two courses of study. You are encouraged to choose two differentinstitutions rather than two different courses at the same institution. If youra lication for the first choice of stud is unsuccessful AusAID will forward our

Preference 1

CRICOS code Institution

Level of study (e.g.Bachelor, Masters,PhD)

Type of study (e.g.Coursework,Research,

Course duration(weeks)

Minimum Englishlanguageproficiency

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http://www.ausaid.gov.au/scholarhttp://www.ausaid.gov.au/scholar


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8. Proposed study continued

Preference 2

Course title

CRICOS code Institution

Level of study (e.g.Bachelor, Masters,PhD)

Type of study (e.g.Coursework,Research,

Course duration(weeks)

Minimum Englishlanguage (IELTS)proficiency

Research proposal details

Complete this section if the studies will be by Research or a combination ofResearch and Coursework. E.g. Doctorate or Masters by Research. Otherwise

proceed to next question. Answers should be concise but sufficient to explain thenature of your research proposal to the selection panel. Please note word limits.

Research title(max 250characters, approx30-50 words limit)

Objectives(max 1000characters, approx150-200 wordslimit)

Significance andpossible applicationof your proposedresearch to yourcountrysdevelopment (max1000 characters,approx 150-200words limit)

Proposed researchmethod (max 1000characters, approx150-200 wordslimit)

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Research proposal details continued

Does your proposed research include Yes No Not sure

If `Yes please provide a description of the fieldwork you will be undertaking. (Max1000 characters, approx 200 words limit).

What is the duration of your proposed Weeks

In which country will you undertake the

Proposed fieldwork supervisor (if known)

9. Qualifications*

List qualifications (whether complete or not) by level of study, starting withthe highest. If you have not completed your studies please list your anticipated enddate. One certified copy of any complete or incomplete official transcripts, certificatesand certified copies of English Language translations must be included with each

1. Qualification name

Level of study

Secondary (High School) Vocational,technical

Under raduate Post raduate

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Qualifications continued

2. Qualification name

Level of study

Secondary (High School) Vocational,technical



6.5, valid for 1 year (2010 or 2011).e.g. if application period opened 11 March2011, test date should be since 11 March 2010. ALAS awardees mustultimately meet the IELTS requirements of their chosen Australian university

, when do you expect to complete Tes

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11. Computer literacy*

Please answer the following questions to the best of your ability. This will assistAustralian institutions to decide whether to provide additional tuition.

Are you computer literate? Yes No

How regularly do you usea PC?

Occasionally Daily Weekly

Monthly

Do you have experience with the following software?

Word processingsoftware (e.g.Word)?

YesNo

Spreadsheetsoftware (e.g.Excel)?

YesNo

Database software(e.g. Access)?

YesNo

Operating systems(e.g. Windows2000)?

YesNo

Presentationsoftware (e.g.PowerPoint)?

Yes

No

Email software (e.g.

Outlook)?

Yes

No

Internet browsers(e.g. InternetExplorer)?

YesNo

Statistical packages(e.g. SPSS orMinitab)?

YesNo

12. Computer training details

List any formal computer courses you have undertaken.

Course name 1

Start date / / End date / /

Course name 2


13. Current employment

Current employment may include work experience and voluntary work. Please enterNot Applicable in the Position Title if you are not currently employed.

Position title

Organisation

Level of position inorganisation structure(eg. Position No. 1 being

Datecommenced

/ /

Sector/organisation Government/public NGO /civil society

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Current employment continued

Do you intend to return to this organisation after your Yes

If Yes, how willthis scholarshipcontribute to the

organisationshuman resourcedevelopmentneeds? (max 500characters, approx80-100 words limit)

If No, what areyour plans whenyou finish yourstudies? (max 500

characters, approx80-100 words limit)

14. Previous relevant employment

Only provide previous employment that is relevant to your application. Employmenthistory should also include work experience, community work and voluntary work.

1. Previous position

Position title

Organisation


Duties/responsibilities(max 500characters, approx80-100 words limit)

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Previous relevant employment continued

2. Previous position

Position title


Organisation

Duties/responsibilities(max 500characters, approx100 words limit)

15. Supporting statement

Limit your answers to 500 characters, approx 80-100 words, per question. Attach apage if not enough room on this form. Please note word limits. Anything over

1. Why do you want to study in Australia?*

2. What skills and knowledge do you hope to gain and how do you propose

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Supporting statement continued

3. How will the proposed training be of benefit to your country of

4. Please indicate thedevelopment theme

that is most relevant toyour application.*

DisabilityDisaster risk reductionEconomic growth

EducationEnvironmentFood securityGender equality

GovernanceHealth, HIV/AIDS,

pandemics

Human rightsInfrastructureRegional stabilityRural development

5. Do you currently have any connection or relationshipto any staff employed at AusAID Posts or with AusAIDsmanaging contractors?*

s ecial assistance or e ui ment to artici ate in the Scholarshi selection

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16. Leadership Award (Masters and PhD applicants only)

To receive a Leadership Award, you must demonstrate your leadership qualities andpotential to influence change. Refer to the Handbook for further details on the

Do you wish to be considered for a Yes No

If `No, please go to Section 17 check list of documentary evidence. If Yes, answer the

following questions.. Limit your answers to 1000 characters, approx 150-200 words, peruestion. Attach a a e if not enou h room on this form. Please note the word

1. How have you contributed to solving a challenge? (In your responseinclude: what aspect/s of your leadership knowledge, skills and practice youconsider to be well established and effective; which people or organisations

2. What specific development issue in your country do you plan to work onafter completing your intended studies and why?

Leadership Award (Masters and PhD applicants only) continued

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3. What would you expect to gain from the Leadership Award? Outline keyareas of your leadership knowledge, skills and practice you wish to develop.

4. What is the importance of expanding your professional networks andcoalitions in regard to effecting positive change and development in your

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17. Professional memberships

The associations and organisations of special interest may include community,cultural, political, scientific, professional and/or educational.

1. Organisation Name

Highest position held







Start date / /


18. Communication*

Where did you first learn of the Australia Awards Development

AusAID scholarshiprecipient

Australia Awardswebsite

AusAID or ManagingContractors Office

Friend, relative orcolleague

AusAID WebsiteHome institution oruniversity

Australian Embassyor AustralianEducation Centre(specify location)

Australian institutionor university (specify) Publication, Radio,

TV (specify)

Workplace or nominatingauthority (specify)

Other (specify)

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19. Checklist of documentary evidence

Please note: You are responsible for providing all supporting documents areprovided. If you do not provide all required documents your application will berejected.

> THREE COPIES of the completed application form.> At least one copy of the application form should have certified* copies

attached of the relevant documents listed below.> Where original documents are not in English, you must provide certified*

copies of official English translations.Required documentation: please tick if you have attached the followingdocuments in support of your application.

All applicants:

Proof citizenship i.e. birth certificate /passport if available andphotographic identification i.e student card drivers licence ifpassport is not available.

Yes N/A

IELTS or TOEFL resultsAll applicants MUST have English Language Proficiencyequivalent to IELTS 6.5, valid for 1 year (2010 or 2011).e.g. ifapplication period opened 11 March 2011, test date should besince 11 March 2010.ALAS awardees must ultimately meet the IELTS requirementsof their chosen Australian university course(which ranges from6.0 to 7.5). This information can be found on universitywebsites.

Yes N/A

Statement from university or school that English is thelanguage of instruction

Yes N/A

Official post-secondary and tertiary certificates/degrees Yes N/A

Official translations of post-secondary and tertiary

certificates/degrees

Yes N/A

Official post-secondary and tertiary transcripts of results Yes N/A

Official translations of post-secondary and tertiary transcriptsof results

Yes N/A

Referee reports Yes N/A

Research applicants only:

Reports from two academic referees (if not available, pleaseexplain why)

Yes N/A

List of relevant publications Yes N/A

Other:

Any other relevant documents in support of your application.(Some countries will require other documents. Please refer tothe website or seek advice from the relevant AusAIDoffice/Managing Contractor.)

Yes N/A

Please list:

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* Certified: a statement that the document is a true copy, signed by aCommissioner of Oaths, Public Notary or other formally recognised authority. Ifyou are unsure about who is the appropriate person to certify your documents,you should contact an AusAID officer at the Australian Diplomatic Mission for yourcountry of citizenship.

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20. Applicants authorisation, agreement, declaration and signature*

Authorisation

AusAID must comply with the Privacy Act 1988 in relation to the personal informationyou have provided in this form.

By submitting this form I authorise AusAID, or its appointed managing contractor, toaccess and/or obtain information, including copies of any of my relevant academic

records/reports from the education institution(s) that I have attended for the followingpurposes:

for use in the selection process for an Australia Award

to monitor my academic performance at my host institution while studyingunder an Australia Award

to brief relevant Australian officials, Ministers and members of Parliament.

Should I receive an Australia Award, I consent to the Australian Government using anddisclosing extracts of my application (relating to my academic background andachievements, leadership skills and my proposed study program in Australia) inpromotional material in hardcopy and on the Internet. I note that promotional material

may include, but is not limited to, media releases and information circulated toAusAIDs offshore Posts and Australian education institutions, concerning the AustraliaAwards.

I authorise AusAID to disclose the personal information collected in this form to otherAustralian Government departments for the purpose of promoting and managing theAustralia Awards.

Understanding

I understand and confirm that:

I have read and complied with the Scholarships Handbook and that the contentsof my application are true and correct

AusAID has the right to vary or reverse any decision regarding an AustraliaAward made on the basis of incorrect or incomplete information

Decisions of the selection panel are final and confidential and nocorrespondence about outcomes of the selection process will be entered into.

Agreement

If successful in gaining an Australia Award, I agree that I will:

undergo a police or character check before my Australia Award is confirmed

immediately provide AusAID with details of any incident that may reflect badlyon the prestige of an Australia Award

act in a manner befitting a recipient of an Australia Award

use the funds for the purposes granted

acknowledge the assistance given by the Australian Government in any writtenreports, publications or publicity associated with the Award.

Declaration and acknowledgement

I declare, in submitting this application form, that the information contained in it andprovided in connection with it is true and correct.

I acknowledge that giving false or misleading information is a serious offenceunder the Criminal Code Act 1995 of the Commonwealth of Australia.

Full Name Signature Date

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alas 2012 application form

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