1

Australian Development Scholarships

2012 Intake Application Form
for GoI Key Agency Candidates Only
Instructions
Please print neatl y using block letters (huruf cetak) and black ink
> Before completing this form, you must read the Australia Development Scholarships Handbook (The Handbook)
and your Countrys profile, available on the AusAID Website (see below) or from the AusAID/Managing
Contractors office in Indonesia. Brief information about the program is also included in this application form. Also
see www.adsindonesia.or.id
> You must complete all fields marked with an * and all relevant sections.
> This application must be completed in English.
> For Yes or No questions, indicate your response with an X in the appropriate box.
> Three (3) copies of this form and of all attached documents must be received by 26 August 2011 at the
Australi a Awards Office at Gedung Wirausaha, 7
th
Floor. Jl . H.R. Rasuna Said Kav.C-5
Kuningan, Jakarta 12940.
> DO NOT send this application to universities or other institutions in Australia.
> Australian Development Scholarships will be offered onl y to those whose course of study will contribute
to the long-term development needs of Indonesia. A list of the development priorities is available under
Choosing a Course of Study on page 3 of this application form.
> AusAIDs website includes a list of Australian Universities that may receive Development Scholarship awardees.
Course of study information is available directly from the Universities websites or the Commonwealth Register of
Institutions and Courses for Overseas Students (CRICOS) website (see below).
> You may provide two preferences for courses of study. You should consider two Australian universities rather
than two courses at the same university, just in case you do not meet the admissibility requirements of the first
Australian university.
> If your application is successful, you will be required to sign a Contract with the Commonwealth of Australia and
be bound by conditions of the scholarship. A full list of the conditions is contained in this application form (page
27 - 28) and in the Handbook. Please note that AusAID reserves the right to change these conditions at any time.
> Submitting this application does not guarantee that you will receive a Scholarship.
> If you do not receive an invitation to an interview from the Australia Awards Office by mid-December, you should
assume that your application has been unsuccessful.
> Before applying, all Public sector applicants are required to have section 23 of the form completed by the
relevant training or foreign cooperation bureau or their university rector (whichever is applicable).
> Applicants in the Open category are not required to fill in section 23. Their applications are to be submitted
directly to the Australia Awards Office at the address above.
> Applicants must not fill in section 25. This section is for use by the Ministry of State Secretariat of the Republic of
Indonesia (SetNeg) and refers only to selected candidates.
> In cases where information supplied by candidates is found to be inaccurate or incorrect, an award offer may be
revoked without notice.
The closing date is 26 August 2011
Applications should be submitted as early as possible

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General Information Notes
Australian Development Scholarships (ADS) provide opportunities for Indonesians to study in Australia at
POSTGRADUATE level.
Up to four hundred scholarships are expected to be awarded in 2012 for commencement in 2012/2013.
Candidates must undertake study in one of the four areas of development priority (see page 3).
ADS are offered in two main categories: Public Sector Category and Open Category.
Public sector applicants are employees from Government organizations, state universities and state owned
enterprises. Their applications must be approved by training or foreign cooperation bureaus (BKLN) of their local or
central agencies before being submitted to the ADS Program Office. Public sector candidates from government
agencies outside J akarta may apply directly to the ADS Program Office with the approval of their relevant Kakanwil or
Kadinas. Calon Pegawai Negeri Sipil are not eligible to appl y.
Open Category applicants are from private organisations and universities and this category is also open to recent
university graduates. No prior Government approval is required for people applying in the Open Category, and
applications are to be submitted directly to the Australia Awards Office. They require, where relevant, the
endorsement of the agency, institution or private university in which the applicant is working or studying. Applications
are submitted directly to the Australia Awards Office.
Public servants (Pegawai Negeri) cannot appl y in the Open category.
A third category (Targeted) exists for candidates who are identified by their organisations in consultation with the
ADS Program. Candidates within this category must be identified by their home organization and must not apply to
the ADS Program independently of their employer.
`Targeted Category' candidates are employed by organisations which are identified by the Government of Indonesia
and Government of Australia (through AusAID) as being strategically aligned with the Development priorities of the
Government of Indonesia.
Scholarships are for full-time study for a Masters or Doctorate degree from Australian tertiary institutions. The
scholarship provides up to nine months full-time language and academic preparation in Indonesia. Students must
achieve satisfactory results in this training to be able to continue their scholarships.
Applications from people with disabilities or from people in organisations working with the disabled are
encouraged to appl y.
Women and candidates in provinces within the geographic focus of AusAID's Country Strategy (see page 4) are also
encouraged to apply.
Eligibility
IN GENERAL CANDIDATES MUST:
> be an Indonesian citizen and not have permanent residence in Australia or New Zealand
> not be married or engaged to a person who is eligible to hold Australian or New Zealand citizenship or permanent
resident status, at any stage of the application, selection, mobilisation processes or while on-scholarship in
Australia
> satisfy Australian Government requirements for international student entry to Australia (health, character etc)
> not hold or have held a Government of Australia Scholarship to study outside Indonesia in the 24 months
preceding the application 24 months to be calculated from the date of arrival back in Indonesia to the
Scholarship application closing date
> be applying to commence a new course of study and not be seeking support through ADS for a course already
commenced in Australia.
> be able to take up the scholarship in the year for which it is offered
> be able to satisfy all requirements of the Department of Immigration and Citizenship (DIAC) for an AusAID student
visa and
> be able to satisfy the admission requirements of the Australian university at which the Scholarship is to be
undertaken.

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SPECIFICALLY, CANDIDATES MUST:
> be applying for courses that fall within the areas of development priority (see Choosing a Course of Study below)
> at the time of application, be no more than 42 years of age
> have a Grade Point Average (GPA) of at least 2.9 on a scale of maximum 4.0 (or 2.75 for applicants from
geographic focus of AusAID Country Strategy only, see page ii) and an English language proficiency of at least
5.0 in IELTS (or 500 in paper-based TOEFL or 39 in Internet based TOEFL). The IELTS or TOEFL result must be
current (a test result obtained in 2010 or 2011 will be considered current). No other English language test
(including TOEFL prediction test) results will be accepted. Contact details of test centre must be provided for
verification of TOEFL test results.
> already hold an undergraduate degree, if applying for a Masters
> already have a Masters, if applying for a Doctorate
> apply for a degree at a level higher than their current highest qualification
> if applying for a Doctorate, applicants will be restricted to staff of universities, higher education institutions,
research institutes, key policy makers and targeted candidates in other agencies associated with AusAID activities
> it is highly desirable for Doctorate applicants to have a letter of support from an Australian university for their
proposed field of study
> answer all relevant questions on the application form
> be willing and available to undertake full-time (Monday - Friday 0800-1600) English for Academic Purposes
(EAP) training in Indonesia prior to studying in Australia, if offered a scholarship.
Choosing a Course of Study
Candidates are encouraged to apply to study courses which fall within AusAID's priority development areas (PDA).
The PDA relate directly to the strategic objectives contained in the Australia and Indonesia Country Strategy. An
indicative list of the areas for study follows.
Australia
Indonesia
Partnership
Priority
Development
Areas (PDA)
Sustainable Growth and
Economic Management
Democracy Justice and
Good Governance
Investing in People Safety and Peace
Description of
PDA
Improving economic policy
and management, reducing
constraints to growth in
infrastructure and
productivity, and improving
natural resource
management, environmental
governance and response to
climate change.
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public
financial management.

Better quality, access
and governance in
education, and better
health access and
systems
Improving responses to
humanitarian needs,
emergencies and
vulnerability to
disasters, and
improving capacity to
ensure transport
security and to counter
threats from
transnational crime.

Australia
Indonesia
Partnership
Priority Fields
of Study
Natural Resource
Management
Agriculture
Aquaculture/fisheries
Forestry
Climate Change
Economics
Infrastructure Planning
Water and Sanitation
Rural Growth
Small and medium
enterprise development
Law, legal and
judicial systems
Political Science and
Government
Public administration
Public expenditure
management
Public Sector
Reform
Environmental Law
Anti-corruption
Decentralisation
Monitoring &
Evaluation
Communicable
Disease Prevention
Health
Management
Health Services
Maternal and Child
Health
Women and
Gender Studies
Disability Services
Public Health
Education and
Training
Education
Management
Human Resource
Development
Childhood Special
Education
Conflict Resolution
Disaster
Prevention and
Management
Transport Safety
Transnational
Crime Prevention
Development
Studies
International
Studies
NB: If your study area is not listed here, you may still apply for a field of study related to the work of AusAID in
Indonesia. For more information see the Australia Indonesia Partnership Country Strategy at:
http://www.indo.ausaid.gov.au/docs/aipstrategyinfo.html

4
Candidates considering study for particular professions should note that ADS does not include the practical training
period required for professional registration, e.g. medical internships, legal articles etc. Successful awardees are
expected to complete such training in their own country.
Selection Process
All applicants are considered by an independent J oint Selection Committee comprised of Australian and Indonesian
academics. Only those shortlisted will be interviewed. The interview will assess candidates' academic ability, clarity of
study goals, cultural adaptability. A critical consideration will be how well the ADS applicant is able to explain the
relevance of their proposed study area to the development of Indonesia. The interview will be accompanied by an
IELTS test of English language proficiency.
Final selection is objective and based on the principles of merit and equity. The final list of awardees is subject to
scrutiny and endorsement by AusAID and Government of Indonesia - State Secretariat.

SELECTION QUOTAS:
In the 2011/2012 ADS cycle, up to four hundred (400) ADS scholarships are available for commencement in
2012/2013. The scholarships are allocated as follows:
> 2/3 of all awards will be offered in the `Public Sector' category
> 1/3 of all awards will be offered in the `Open' category
> up to 50 percent of awards will be offered in the Targeted Sector Category
> up to 30 percent of all scholarships will be awarded in line with geographic focus of the Country Program Strategy.
(The geographic focus will include East Nusa Tenggara, West Nusa Tenggara, Papua, West Papua, and
Aceh)
> 90 percent of awards at Masters level (360) and 10 percent at Doctorate (PhD) level (40). (NB doctoral level
study is only open to staff of universities, higher education institutions, research institute, key policy makers and
targeted candidates in other organizations associated with AusAID activities. Up to eight (8) PhD awards will be
made available to eligible candidates within the Targeted Category
> an equal number of awards will be offered to men and women.

NOTIFICATION OF THE SELECTION RESULT
All applicants will be advised whether or not they have been selected for an interview. All interviewed applicants will
be notified whether or not they have been awarded an ADS. The result is final and no correspondence will be entered
into. Where appropriate, notification will include details of pre-departure training (English, academic skills, cultural
preparation). This training is compulsory and full-time (see page 6 for step by step of ADS Application Process).
Requirements for Scholarship Recipients
Prior to travelling to Australia, schol arship recipients must:
> meet the minimum English language requirement of their chosen Australian university (usually IELTS of 6.5 with
no band less than 6.0)
> at the completion of EAP training, candidates must achieve a minimum score of IELTS 6.0 for ADS office to
commence the application process for placement in a university program in Australia
> receive a letter of acceptance from an Australian university
> meet Australian immigration requirements for a student visa
> receive Government of Indonesia endorsement
> be medically fit to commence studies in Australia.


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In Austral ia, scholarship recipi ents must:
> abide by the conditions of the scholarship and the rules of Australian tertiary institutions
> abide by the rules and regulations governing a student visa
> act in a way that will not bring disrepute to AusAID, or to any Australian university or to Indonesia
> return to Indonesia for a period of two years at the completion of their study/research program in Australia. If
during the two years exclusion period the scholarship recipients return to Australia, a debt to the Commonwealth
may be activated OR any time spent in Australia may be added to the two year exclusion period. Calculation of
the two years exclusion period starts when the scholarships recipients arrive Indonesia, not the visa expire date.

What do Australian Development Scholarships cover?
> Pre-Course English provision of English for Academic Purposes training prior to commencement of studies in
Australia (including an in-Indonesia stipend)
> Tuition Fees - payment of full academic fees and any other fees compulsory for international students.
> Introductory Academic Program (IAP) the provision of a 4-6 week Introductory Academic Program prior to the
commencement of studies.
> Editorial/tutorial assistance - provided where it is deemed essential to assist awardees to pass course subjects.
> Travel - payment of an economy airfare from the principal international airports in Indonesia (J akarta or Denpasar)
to the major airport nearest the Australian university and return travel to Indonesia. A separate reunion airfare will
be available to the student after the successful completion of the first year of study; subsequent reunion airfare
entitlements will be available on an annual basis for the duration of the ADS, except for the final year of the ADS.
> Overseas fieldwork - holders of a scholarship where research comprises at least 50 percent of the program may
receive a return economy class airfare to Indonesia to undertake essential fieldwork.
> Contribution to living expenses (in Australia Stipend) - payment of a fortnightly contribution to living expenses
(CLE).
> Overseas Student Health cover (OSHC) - awardee only (awardees are required to maintain OSHC for any
accompanying family in order to satisfy visa requirements).
> Provision of an AusAID Student Visa and Student Dependant visa.

Family Entry
Awardees can bring their immediate families to Australia at their own cost, if their families meet AusAID and
immigration requirements. Families are normally permitted to join eight (8) weeks after the awardee's arrival.

Useful websites
Australia Awards: http://australiaawards.gov.au/
Australia Awards Development Scholarships: http://www.ausaid.gov.au/scholar
Australian Development Scholarship (ADS) Indonesia: http://www.adsindonesia.or.id
Visas Department of Immigration and Citizenship: http://www.immi.gov.au
Studying in Australia: http://www.studyinaustralia.gov.au
Australian Educational Institutions and courses - the Commonwealth Register of Institutions and
Courses for Overseas Students (CRICOS): http://cricos.deewr.gov.au
IELTS: http://www.ielts.org.au
TOEFL: http://www.ets.org/toefl


6

The ADS Application Process



Step 1
Applicant sends complete
ADS application form to
Australia Awards Office by
26 August 2011.
Step 2
Applicant is notified of
the result of selection for
interview by December 2011.
Step 3
Applicant selected for
interview receives
information of interview/
IELTS test date/location.
Step 4
Applicant attends
interview and IELTS test
in January 2012.
Step 5
Applicant is advised of
the result of their ADS
application by February 2012.

7




Australian Development Scholarships
2012 Intake Application Form
for GoI Key Agency Candidates Only



1. Personal details
Provide supporting documentary evidence of your full name, date of birth, gender and country of
citizenship. For example, the identification page of your passport or other official identification
document issued by your country of citizenship.

* Denotes mandatory field
Attach a recent
passport size photo.
3 x 4 cm.
Title*

Given name*
Enter your family name and other names as shown in your
Birth Certificate, Passport or other official identification
document. If you have only one name, enter it in both fields.
Family names*
Date of birth* dd/mm/yyyy Gender*
Place of birth*
(State/province)
Ethnic group?
Which country are you living in now?*
Have you applied, or are you intending to apply, for permanent
residency or citizenship in Australia or New Zealand?*

National Identity Number
(KTP No.)

Passport no.
(provide if you have a
passport).*

Issue date

Expiry date

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2. Contact details
Residential address (Please check that your contact details are correct. The scholarship application takes several months to be finalised. If you
cannot be contacted, your application will not proceed.)

Address line 1*
Address line 2
Address line 3
Town/City*


State/Province* Postal code (if any)
Country*

Mailing address (Provide details only if this is different to your current residential address.)
Address line 1
Address line 2
Address line 3
Town/City

State/Province Postal code (if any)
Country
Phone and email (Provide at least one contact number.)
Home phone no.* Work phone no.
Mobile no. Fax no. (if any)
Email 1
Email 2

Current Work address (Please provide your current work address where you can also be contacted. If you cannot be contacted, your application
will not proceed.)

Address line 1*
Address line 2
Address line 3
Town/City*


State/Province* Postal code (if any)
Country*


9

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 scholarship does not provide financial support for accompanying dependants.
You can get information on your responsibilities for your spouse and any dependant children, should they live with you in
Australia during your scholarship, from the Department of Immigration and Citizenship (DIAC) or by contacting the
university where you want to study.
Given name*
Provide family name and other names as shown in your spouses
birth certificate, passport or other official identification document*
Family names*
Date of birth* dd/mm/yyyy Gender*
Passport no.
Provide if spouse
has a passport.*

Issue date
Expiry Date
Country of
citizenship

Will your spouse accompany you to Australia?*


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 in Australia.
A dependent child is the child or stepchild, of yourself or your spouse, who is not married or engaged to be married and
has not turned 18 years of age.
NB: This Scholarship does not provide financial support for family members accompanying you to Australia.
Information on your responsibilities for any children that will live with you in Australia during your scholarship can be
obtained from the Australian Government Department of Immigration and Citizenship website or by contacting the
university where you want to study.
Child 1 Will this child accompany you to Australia?*
Family name
Given names
Date of birth dd/mm/yyyy Gender
Country of citizenship
Passport no.
Provide if child has a
passport.*

Issue date
Expiry date

Child 2 Will this child accompany you to Australia?*
Family name
Given names
Date of birth dd/mm/yyyy Gender
Country of citizenship
Passport no.
Provide if child has a
passport.*

Issue date
Expiry date

10

Children details continued
Child 3 Will this child accompany you to Australia?*
Family name
Given names
Date of birth dd/mm/yyyy Gender
Country of citizenship
Passport no.
Provide if child has a
passport.*

Issue date
Expiry date

5. Emergency contact details*
Provide details of a person that can be contacted in case of an emergency. This may be a relative or a friend.
Title*
Family name*
Relationship to
you*

Given name* Gender*
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 any)
Country*
Please check that the contact details are correct


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 or a fellowship?*
1. Scholarship/fellowship title
Start date End date Country
Qualification (if applicable)
University



11

Previous scholarships continued
2. Scholarship/fellowship title
Start date End date
Qualification (if applicable)
University


7. Scholarship applications
Have you previously applied for an AusAID scholarship but were
unsuccessful?*

If "Yes" how many times have you previously applied for ADS?

Have you previously been interviewed by ADS?*
If Yes, in which years?



8. Disability
Awardees with disabilities are encourage to apply for an ADS. If you do have a disability, the provision of details on
disability will enable appropriate measures to be put in place in the ADS Program.
Do you have a disability or do you work in a disability-focused
organisation?

If "Yes", please give details and attach any medical assessment if relevant.



9. Under Which GoI Key Agency are you applying for an ADS? *
GoI Key Agency name:


Please indicate your GoI Key Agency category:


Please also select if you are:



Please specify
Please specify
Please specify

12

10. Proposed study program*
AusAID will consider offering you a scholarship only if your course of study will contribute to the long-term development
needs of your country. Note that the proposed program of study should be appropriate to your academic qualification and
work experience.


Requested Level of study*
(You will not be allowed to
upgrade your course from the
level at which you are first
placed).

Type of study* (Masters
coursework program can contain a
research project up to 30% of the
Masters. Candidate decide the topic
during course)

Research background of Doctorate(PhD) candidates only:*
Do you hold a Masters degree with > 50% weighting for research?
Are you including a letter from your Masters supervisor recommending that you should pursue Doctorate
studies? (Recommended)

Proposed field of study*
You are required to:
Identify the priority Development Area (PDA) for your proposed studies.
Identify the Priority Field of Study (PFS) from the list of preferred PFS provided
If necessary, you may nominate another Field of Study in 'other' (Please select other and provide detail).
Australia
Indonesia
Partnership
Priority
Development
Areas (PDA)*


Description
of PDA
Sustainable Growth
and Economic
Management
Improving economic
policy and management,
reducing constraints to
growth in infrastructure
and productivity, and
improving natural
resource management,



Democracy Justice
and Good
Governance
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public


Investing in People
Better quality, access and
governance in education,
and better health access
and systems
Safety and Peace
Improving responses to
humanitarian needs,
emergencies and vulnerability
to disasters, and improving
capacity to ensure transport
security and to counter threats
from transnational crime.

Australia
Indonesia
Partnership
Priority
Fields of
Study (PFS)*


13

Proposed study program* continued
Have you obtained information from the ADS Information CD, or from the ADS
website regarding study options in Australia?

Please describe the efforts you have undertaken so far to obtain information on your study options in Australia.

ADS - Australian Universities List
Following Australian universities are under contract to AusAID to provide courses for ADS awardees. Awardees are
required to find a suitable course of study at one of these Australian universities. PhD candidates must find a supervisor at
one of these universities. Please visit the following website for more details on Australian Educational Institutions and
courses - CRICOS: http://cricos.deewr.gov.au
Australian Maritime College
Australian Catholic University
Carnegie Mellon University
Central Queensland University
Charles Darwin University
Charles Sturt University
Curtin University of Technology
Deakin University
Edith Cowan University
Griffith University
James Cook University
La Trobe University
Macquarie University
Monash University
Murdoch University
Queensland University of Technology
RMIT University
Southern Cross University
Swinburne University of Technology
The Australian National University
The Flinders University of South Australia
The University of Adelaide
The University of Melbourne
The University of Queensland
The University of Sydney
The University of Western Australia
UCL School of Energy and Resources
University of Ballarat
University of Canberra
University of Newcastle
University of New England
University of New South Wales
University of South Australia
University of Southern Queensland
University of Tasmania
University of Technology, Sydney
University of the Sunshine Coast
University of Western Sydney
University of Wollongong
Victoria University
Bond University
The University of Notre Dame Australia
Proposed preferences
If you are selected for the scholarship the Australia Awards Office will forward your application to your prefer Australian
university and course of study. You need to decide which Australian university you want to attend and choose an
appropriate course. You should choose two courses of study. You are encouraged to choose two different Australian
universities rather than two different courses at the same university. If your application for the first choice of study is
unsuccessful, AusAID will forward your application to your second choice. The CRICOS code from your course can be
found on the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) Website
http://cricos.deewr.gov.au

To find out about the content of specific courses, you should refer to the individual Australian university websites. This
information can also be found on the ADS Information CD which can be obtained from the Australia Awards Office or ADS
website http://www.adsindonesia.or.id.
Preference 1*

Course title or particular focus
area within your identified
proposed Field of Study.*
CRICOS code (if applicable)*
Australian University
(if applicable)

Course duration (weeks)
(if applicable)

Minimum English
language proficiency
required for the course
(IELTS) (if applicable)



14

Proposed preferences continued
Preference 2*

Course title or particular focus
area within your identified
proposed Field of Study.*
CRICOS code (if applicable)*
Australian University
(if applicable)

Course duration (weeks)
(if applicable)

Minimum English
language proficiency
required for the course
(IELTS) (if applicable)


A formal offer of admission will not be required however it is expected serious
PhD candidates will have made preliminary enquiries to possible Australian
universities regarding their study.

Have you discussed your proposed course with a member of staff from any
Australian university? This is highly recommended for PhD applicants. If Yes,
please attach any relevant correspondence with Australian universities.

Are there any special subjects or skills development that you would like to include
in your choice?

If "Yes" please give details. (Note that ADS does not include the practical training period required for professional
registration, e.g. medical internship, legal articles etc. Applicants are expected to complete such practical training in their
own country).




15

Research proposal details
Complete this section if the studies will be by Research or a combination of Research and Coursework. E.g. Doctorate
or Masters by Research. Otherwise proceed to next question. Answers should be concise but sufficient to explain the
nature of your research proposal to the selection panel. Please note word limits. Anything over this limit will not be
considered.
Research title
(max 250 characters,
approx 30-50 words limit)




What is the background to
the research being
proposed? (maximum 150
words / + 1,000
characters)








Provide a Research
Statement (purpose of
study) to accompany the
proposed research. This
can include a statement on
what is special and unique
about the research?)
(maximum 100 words / +
700 characters)









What hypothesis are you
testing in your proposed
research? (maximum 50
words / + 350 characters)







What are the objectives of
the proposed research?
(maximum 200 words / +
1,300 characters)



16

Research proposal details
What is the
methodology/structure in
your proposed research?
(include comments on
measurements, data
sources, methods of
analysis and timelines)
(maximum 200 words / +
1,300 characters)


Have you published any
research to date? (include
texts, journal articles
providing full citation)


Which university do you
consider appropriate for
your proposed studies?
Why? (maximum 50 words /
+ 350 characters)


Have you considered a
possible research
supervisor? Why this
selection?(maximum 50
words / + 350 characters)


What is the relevance of
the proposed research to
Indonesia?


Does your proposed research include fieldwork?*
If `Yes please provide a description of the fieldwork you will be undertaking. (Max 1000 characters, approx 200 words
limit).




What is the duration of your proposed fieldwork? (if known) Weeks
In which country will you undertake the proposed fieldwork?
Proposed fieldwork supervisor (if known)


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11. Qualifications*
List qualifications (whether complete or not) by level of study, starting with the highest. If you have not completed
your studies please list your anticipated end date. Applicants are required to fill out the total GPA obtained and the
maximum GPA possible for each qualification noted below.
Three certified copies of official transcripts and certificates MUST be included with this application. If you are selected for
interview, you MUST provide certified English translations when you attend the interview.
1. Qualification name*
Level of study*
Name of university*
State/Province Country*
Language of instruction* Start date *
GPA (if applicable) Obtained / Max End date*
Status

2. Qualification name*
Level of study*
Name of university*
State/Province Country*
Language of instruction* Start date*
GPA (if applicable) Obtained / Max End date*
Status

3. Qualification name
Level of study
Name of university
State/Province Country
Language of instruction Start date
GPA (if applicable) Obtained / Max End date
Status


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12. English language proficiency*
Applicant must have an English language proficiency of at least 5.0 in IELTS (or 500 in paper-based TOEFL or 39 in
internet-based TOEFL). The IELTS or TOEFL (Institutional or International) result must be current (a test result obtained in
2010 or 2011 will be considered current). An original copy of your IELTS or TOEFL certificate must be attached to the
application form. NO other English language test (including TOEFL prediction) result will be accepted.
Is English your first language?
If `Yes go to next section. If `No answer the following questions:
Was English the language of your highest level of study?
If `Yes, provide a statement from the university verifying the language of instruction.
Have you taken an IELTS or TOEFL test?
Test name (e.g.
IELTS or TOEFL)

Date test
taken

Overall
score

Test Centre/location Phone Website
If `No, when do you expect to complete the
test?
Test name

13. Computer literacy*
Please answer the following questions to the best of your ability. This will assist Australian universities to decide whether
to provide additional tuition.
Are you computer literate?*
How regularly do you use a PC?*
Do you have experience with the following software?*
Word processing software
(e.g. Word)?

Spreadsheet software (e.g.
Excel)?

Database software (e.g.
Access)?

Operating systems (e.g.
Windows 2000)?

Presentation software (e.g.
PowerPoint)?

Email software (e.g.
Outlook)?

Internet browsers (e.g.
Internet Explorer)?

Statistical packages (e.g.
SPSS or Minitab)?


14. Computer training details
List any formal computer courses you have undertaken.
Course name 1
Start date End date
Course name 2
Start date End date



19
15. Current employment
Current employment may include work experience and voluntary work. Please enter Not Applicable in the Position
Title if you are not currently employed. You must provide a current CV.
Position title*
Organisation*

Level of position in
organisation structure
(eg. Echelon and Golongan)
Date commenced*
Sector/organisation type

Briefly describe the work of
your organisation and the
service it provides.


Briefly describe your current
duties and responsibilities
(max 500 characters, approx
80-100 words limit)








Do you intend to return to this organisation after your scholarship in Australia?*
If Yes, what role and
responsibilities do you
expect to undertake after
your academic studies?
(max 500 characters, approx
80-100 words limit)











What specific tasks do you
anticipate being able to
undertake after your
academic studies? (specify
at least 3) (max 500
characters, approx 80-100
words limit)













20

16. Previous relevant employment
Only provide previous employment that is relevant to your application. Employment history should also include work
experience, community work and voluntary work.
1. Previous position
Position title
Organisation

Start date End date
Duties/responsibilities
(max 500 characters, approx
80-100 words limit)












2. Previous position
Position title
Start date End date
Organisation

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












17. Interview Centre *
Please select your preferred interview center. (Please note Your choice is not guaranteed.)



21

18. Supporting statement
Limit your answers to 500 characters, approx 80-100 words, per question. Attach a page if not enough room on this form.
Please note word limits. Anything over this limit will not be considered.
1. Why do you want to study in Australia?*












2. What skills and knowledge do you hope to gain and how do you propose to use them?*

3. How will the proposed training be of benefit to Indonesia?*

















22

Supporting statement continued
4. Do you currently have any connection or relationship to any staff employed at
AusAID Posts or with AusAIDs managing contractors?*

If `Yes please expand.


5. Are you subject to any criminal or civil proceedings that are currently awaiting
legal action?*
If `Yes please expand. Please note information provided here will not necessarily disqualify you from submitting this scholarship application.


6. Is there anything else you would like to add? (E.g. Will you require special assistance or equipment to
participate in the Scholarship selection processes or to live and undertake studies in Australia?)



23

19. Professional memberships
Professional memberships may include community, cultural, political, scientific, professional and/or educational
associations and organisations.
1. Organisation Name
Highest position held (if any)

Start date
End date
2. Organisation Name
Highest position held (if any)

Start date
End date
3. Organisation Name
Highest position held (if any)


Start date


End date

20. Communication*
Where did you first learn of the Australian Development Scholarships?
(specify where asked to do so)

From where did you obtain your application form? (specify where asked to do so)


24

21. Checklist of documentary evidence*
Please note: You are responsible for providing all supporting documents are provided. If you do not provide all required
documents your application will be rejected.
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
if you are selected for an interview.

* Certified: a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notaryor other
formally recognised authority. If you are unsure about who is the appropriate person to certify your documents, you
should contact the ADS Office.

Required documentation: please tick if you have attached the following documents in support of your application.

All applicants: (Essential)
You MUST include all the essential documents. If at least one essential document is not provided, your application will be
automatically rejected.
copies of birth certificate or equivalent
proof citizenship i.e. KTP or your passport personal information pages
current Curriculum Vitae
official (certified* ) post-secondary and tertiary certificates/degrees
official (certified* ) post-secondary and tertiary transcripts of results
current (original) IELTS or TOEFL English language test results (a test result obtained
in 2010 or 2011 will be considered current). TOEFL prediction test is NOT
accepted.

Masters applicants must also attach certified DIII degree certificate/transcript if using
DIV or S1 extension certificate/transcript

Doctorate applicants must also attach certified S1 degree certificate/transcript
academic reference from S2 supervisor for Doctorate candidates
Doctorate and those Masters applicants whose study will include at least fifty percent
research must fill the research proposal details on page 15 of this application form


Additional Documents: (Optional)
Applicants must provide the following documents if they are selected for an interview.
recent photograph (3 x 4)
official (certified* ) English translations of post-secondary and tertiary
certificates/degrees

official (certified* ) English translations of post-secondary and tertiary transcripts of
results

references from S1 supervisor for Masters candidates (if available)
list of relevant publications, unpublished theses (for research applicants)
statement from university that English is a language of instruction (if applicable)
relevant correspondence with an Australian university (if available).
official (certified*) English translations of birth certificate
IMPORTANT:
Attach only certified copies of documents. DO NOT attach original documents.
Application forms and documents will not be returned.



25
22. Conditions of Scholarships
WARNING:
In section 22, 23 and 24 you will be agreeing to important conditions attached to your award and your study in Australia.
Failure to comply with these conditions will mean that you may incur a debt to the Government of Australia and your
scholarship may be terminated.
DO NOT sign the declaration at the end of section 23 and 24 until you fully understand the conditions of the scholarship
award. If you have any problems understanding Section 22, 23 and 24 you are strongly advised to seek clarification of
these conditions from the Australia Awards Office.
If you are offered a scholarship you will be asked to agree to certain conditions before accepting the scholarship. The main
conditions are set out below for your information.
In accepting an Australian Development Scholarship, you will be asked to:
take up the ADS in the academic year for which it is offered;
complete a full study program during the course of their scholarship;
not hold another Australian Government scholarship at the same time as the ADS;
participate in the Pre-Departure Briefing arranged by the Post, and the universitys compulsory Introductory
Academic Program (IAP) on arrival in Australia;
reside in Australia for the duration of the ADS (apart from holidays, reunion visits or fieldwork visits to their home
country);
complete their ADS award within the period stipulated in their Student Contract;
only undertake the approved program for which the ADS is offered and abide by the rules of the university;
maintain an appropriate study load and achieve satisfactory academic progress in the program for which the
ADS was offered;
participate in all activities associated with the approved course of study, including all lectures and tutorials,
submit all work required for the course (e.g. assignments or essays) and sit for examinations;
not undertake any additional off-scholarship tertiary studies during their time in Australia on an AusAID Student
Visa;
be aware that any employment undertaken during term times may compromise academic progress;
liaise with the Student Contact Officer at the university regarding any proposed changes to the approved
program and acknowledge that approval is required from the university, AusAID and Partner Government before
any changes are made;
agree to AusAID collecting information concerning the Student or dependants and passing that information on to
other relevant parties, if necessary;
advise AusAID immediately, via the Student Contact Officer at the university, if they marry a person who is an
Australian or New Zealand citizen, or who has permanent residence status in Australia or New Zealand. The
change in a students marital status may affect eligibility to maintain the ADS Scholarship, and the Debt to the
Commonwealth may apply if the student does not return to their home country for a period of 2 years;
return to their country of citizenship for two years at the completion of their study/research program in Australia;.
be aware that a Debt to the Commonwealth of Australia will be incurred if a Student fails to return to their home
country, or if they apply for Permanent Residence or for a visa to remain in or return to Australia within the two
year period; and
that any time spent in Australia during the two year return home period will accordingly extend the end date of
the two year period;
agree that their ADS may be terminated at any time for failure to make satisfactory academic progress, failure to
comply with the laws of Australia, misconduct, breaches of the contract between the Student and the
Commonwealth of Australia including breaches of the conditions of the ADS or of the AusAID Student Visa or if
they apply to change their visa status.



26
Conditions of Scholarships continued
Subject to your fulfilling these conditions AusAID will provide the following, (either directly or through the Australian
university):
Pre-Course English provision of English for Academic Purposes training prior to commencement of studies in
Australia (including an in-Indonesia stipend)
Tuition Fees - payment of full academic fees and any other fees compulsory for international students.
Introductory Academic Program (IAP) the provision of a 4-6 week Introductory Academic Program prior to
the commencement of studies.
Editorial/tutorial assistance - provided where it is deemed essential to assist awardees to pass course
subjects.
Travel - payment of an economy airfare from the principal international airports in Indonesia (Jakarta or
Denpasar) to the major airport nearest the Australian university and return travel to Indonesia. A separate
reunion airfare will be available to the student after the successful completion of the first year of study;
subsequent reunion airfare entitlements will be available on an annual basis for the duration of the ADS, except
for the final year of the ADS.
Overseas fieldwork - holders of a scholarship where research comprises at least 50 percent of the program
may receive a return economy class airfare to Indonesia to undertake essential fieldwork.
Contribution to living expenses (in Australia Stipend) - payment of a fortnightly contribution to living
expenses (CLE).
Overseas Student Health cover (OSHC) - awardee only (awardees are required to maintain OSHC for any
accompanying family in order to satisfy visa requirements).
Provision of an AusAID Student Visa and Students Dependant visa.

Your university will provide for:
instruction and facilities necessary to complete the specified course
appropriate academic and welfare support for the duration of your studies
airport reception and temporary accommodation arrangements on arrival in Australia.


27
23. Nominating GoI Key Agency Declaration
(NB: To be completed by the Supervisor and Liaison Officer)
Please note that your signature on this form signifies your agreement to the following:
to release the applicant from work duties while he/she attends English for academic training. This training is full-
time and compulsory
to release the applicant from work duties after English for academic training to study in Australia, and process
their official passport and exit permit
to cover the cost of travel to and from English for Academic Purposes training (Bali/Jakarta)
to cover the cost of travel to the point of departure (Bali/Jakarta) prior to travel to Australia to cover the cost of
medical examinations for the applicant. A medical examination is an Australian Immigration requirement to
receive a student visa
to select a field of study and level of study appropriate to the agency's needs.
Please also note that if the application is for Doctorate level study, the signature by the authorised staff member confirms
that the applicant is a lecturer/researcher/key planner or policy maker and that Doctorate level studies are essential for
his/her future research and /or teaching responsibilities.
Name of Ministry/Employer
Name of Applicant
Applicants Position title
Applicants Level of position
in organisation structure
(eg. Echelon and Golongan)
Date commenced
How long have you known the applicant and
in what capacity?


What is the relationship between the
candidates identified study area and the
organisations key priorities?

What position/duties will be assigned to the
candidate upon completion of his/her studies?


28
Nominating GoI Key Agency Declaration continued
What key indicators will be used to evaluate
the candidates performance upon return to
work after studies?








Ministry/Agency Representative signature*
On behalf of the ministry, I the undersigned, agree to be bound to the above commitments and strategies
Full Name Signature & stamp
Position

Email
Mobile
Date

29
24. Applicants authorisation, agreement, declaration and signature*
Authorisation
AusAID must comply with the Privacy Act 1988 in relation to the personal information you have provided in this form.
By submitting this form I authorise AusAID, or its appointed managing contractor, to access and/or obtain information,
including copies of any of my relevant academic records/reports from the Australian University(s) that I have attended for
the following purposes:
for use in the selection process for an Australia Award
to monitor my academic performance at my host university while studying under an Australian Development
Scholarships
to brief relevant Australian officials, Ministers and members of Parliament.
Should I receive an Australia Award, I consent to the Australian Government using and disclosing extracts of my
application (relating to my academic background and achievements, leadership skills and my proposed study program in
Australia) in promotional material in hardcopy and on the Internet. I note that promotional material may include, but is not
limited to, media releases and information circulated to AusAIDs offshore Posts and Australian universities, concerning
the Australian Development Scholarships.
I authorise AusAID to disclose the personal information collected in this form to other Australian Government departments
for the purpose of promoting and managing the Australian Development Scholarship.
Understanding
I understand and confirm that:
I have read and complied with the Scholarships Handbook and that the contents of my application are true and
correct
AusAID has the right to vary or reverse any decision regarding an Australia Development Scholarships made on
the basis of incorrect or incomplete information
Decisions of the selection panel are final and confidential and no correspondence about outcomes of the
selection process will be entered into.
Agreement
If successful in gaining an Australia Development Scholarships, I agree that I will:
undergo a police or character check before my Australia Development Scholarships is confirmed
immediately provide AusAID with details of any incident that may reflect badly on the prestige of an Australia
Development Scholarships
act in a manner befitting a recipient of an Australia Development Scholarships
use the funds for the purposes granted
acknowledge the assistance given by the Australian Government in any written reports, publications or publicity
associated with the Scholarships.
Declaration and acknowledgement
I declare, in submitting this application form, that the information contained in it and provided in connection with it is true
and correct.
I acknowledge that giving false or misleading information is a serious offence under the Criminal Code Act 1995
of the Commonwealth of Australia.

Full Name Signature Date



30
25. Ministry of State Secretariat of the Republic of Indonesia use only
Endorsement by the Government of Indonesia
( To be completed by Head, Bureau of Technical Cooperation, Ministry of State Secretariat of the Republic of Indonesia )
On behalf of the Government of Indonesia, I certify that I have examined the documents attached to this form and am
satisfied that they are authentic and relate to the applicant.
I certify that the maximum level of study, field of study and length of award proposed in this application are appropriate
and in accordance with the Government's training policy.
I endorse the applicant for an Australian Development Scholarship.
Name of certifying officer
Title
Organisation
Official Stamp Signature Date