Development Scholarship Application

Instructions
Please print neatly using BLOCK LETTERS and BLACK INK

> Before completing this form, you must read the Australia Awards Development Scholarship Handbook (The
Handbook) and your Countrys profile, available on the AusAID Website (see below) or from the AusAID/Managing Contractors office in your country.

> You must complete all fields marked with an *. > This application must be completed in English.
> For Yes or No questions, indicate your response with an X in the appropriate box.

> One (1) copy of this form and of all attached documents must be submitted to the AusAID Office in your country
by the Country Programs due date.

> DO NOT send this application to universities or other institutions in Australia. > Australia Awards Development Scholarships will be offered only to those whose course of study will
contribute to the long-term development needs of their country of citizenship. A list of the development priorities is available from the AusAID office in your country of citizenship or the Country profile on the AusAID Website (see below). > AusAIDs website includes a list of Australian higher education institutions that may receive Development Scholarship awardees. Course of study information is available directly from the Institutions 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 institutions rather than two courses at the same institution, just in case you do not meet the admissibility requirements of the first institution. > 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 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 or other communication from AusAID or its Managing Contractor by mid-July, you should assume that your application has been unsuccessful.

Useful websites
Australia Awards: http://australiaawards.gov.au/ Australia Awards Development Scholarships: http://www.ausaid.gov.au/scholar 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
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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 Title* Family name* Given names* Place of birth* (State/provin Country of citizenship* Do you have dual citizenship?* 2nd country of citizenship Mr Mrs Other(Please specify)
dd/mm/yyyy

Ms

Miss

Dr

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.

Date of birth* / /

Gender* Ethnic group?

Male

Female

You must be a citizen of one of the eligible participating countries.

Yes

No

If you are a citizen of Cook Islands, Niue or Tokelau and are entitled to hold a New Zealand passport, please do not list New Zealand as your first or second country of Citizenship.

Which country are you living in now?* Have you applied, or are you intending to Yes No apply, for permanent residency or citizenship in Australia or New Zealand?* National Provide if applicable to your country.* Identity Number Issue date / / Passport no. (provide if you have a Expiry date / / passport).*

2. Contact details Residential address (Please check that your contact details are correct.
your application will not proceed.) If you cannot be contacted,

Address line 1* Address line 2 Address line 3 Town/City* State/Province* Country* Contact details
address.)

continued

Postal code (if

any)

Mailing address(Provide details only if this is different to your current residential Address line 1

Address line 2 Address line 3 Town/City State/Province Country Phone and email Home phone no.* Mobile no. Email 1 Email 2

(Provide at least one contact number.) Work phone no. Fax no. (if
any)

Postal code (if

any)

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. A spouse is the person you are married to or de facto partner (including same-sex partners). A de facto relationship applies if you have been living with a person for at least 12 months, and you have a genuine and exclusive relationship with them. You can get Iinformation on your responsibilities for your spouse and any dependant children, should they live with Family name Given names Date of birth Passport no.
Provide if spouse has a passport.*

/ / dd/mm/yyyy

Provide family name and other names as shown in your spouses birth certificate, passport or other official identification document*

Gend er Issue date

Male
/ /

Female

Expiry Date / /

Country of citizenship

Yes No

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 or in a de facto relationship and has not turned 18 years of age. NB: This Scholarship does not provide financial support for family members accompanying you to Australia. of Immigration and Citizenship website or by contacting the institution where you want to study. Child 1 Will this child accompany you to Australia?* Yes No Family name Given names Date of birth Country of citizenship Passport no.
Provide if child has a passport.*

/ /

dd/mm/yyyy

Gender

Male

Female

Issue date Expiry date

/ /

/ /

Child 2 Family name Given names Date of birth Country of citizenship Passport no.

Will this child accompany you to Australia?* / /

Yes

No

dd/mm/yyyy

Gende r
/ / / /

Male

Female

Provide if child has a passport.*

Issue date Expiry date

Child 3 Will this child accompany you to Australia?* No Family name Given names Date of birth Country of citizenship Passport no.
Provide if child has a passport.*

Yes

/ /

dd/mm/yyyy

Gende r
/ / / /

Male

Female

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. Mr Mrs Ms Miss Dr Title* Please Other specify Relationship to Family name* you* Given name* Home phone* Mobile phone Email 1 Email 2 Address line 1* Address line 2 Address line 3 Town/City* State/Province* Country* Postal code (if
any)

Gender* Work phone Fax (if any)

Male

Female

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 Yes a fellowship?* 1. Scholarship/fellowsh Start date End date Country Qualification (if applicable) Institution 2. Scholarship/fellowsh Start date Qualification (if applicable) Institution

No

Country

End date

Country

7. Scholarship applications Applying for more than one scholarship does not make you ineligible to apply for an AusAID Scholarship. What other scholarships are you currently applying for?

Have you previously applied for an AusAID scholarship 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 will contribute to the long-term development needs of your country. A list of priority fields 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 to receive AusAID scholars. You need to decide which Institution you want to attend and choose an appropriate course. To find out about the content of specific courses, you should refer to the individual Institution websites. Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) Website http://cricos.deewr.gov.au Preference 1 Course title CRICOS code Level of study (e.g. Bachelor, Masters, PhD) Course duration (weeks) Institution

Type of study (e.g. Coursework, Research, Combination) Minimum English language proficiency required for the course

8. Proposed study Preference 2 Course title CRICOS code Level of study (e.g. Bachelor, Masters, PhD) Course duration (weeks)

continued

Institution

Type of study (e.g. Coursework, Research, Combination) Minimum English language (IELTS) proficiency required for course

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) Objectives (max 1000 characters, approx 150-200 words limit)

Significance and possible application of your proposed research to your countrys development (max 1000 characters, approx 150-200 words limit) Proposed research method (max 1000 characters, approx 150-200 words limit)

Research proposal details

continued

Does your proposed research include Yes No Not sure 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? Weeks (if known) In which country will you undertake the proposed fieldwork? Proposed fieldwork supervisor (if known)

9. 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. One certified copy of any complete or incomplete official transcripts, certificates and certified copies of English Language translations must be included with each application form. Any documents not in English must be translated. Add an extra 1. Qualification name Secondary (High School) Level of study Undergraduate Name of institution State/Province Complete Country Start date End date
/ /

Vocational, technical Postgraduate

/ /

Language of instruction Status

Pending results

Incomplete

Qualifications

continued

2. Qualification name Level of study

Secondary (High School) Undergraduate Vocational, technical Postgraduate

Name of institution State/Province

Complete Country Start date End date

/ /

/ /

Language of instruction Status

Pending results

Incomplete

3. Qualification name Level of study

Secondary (High School) Undergraduate Vocational/technical Postgraduate

Name of institution State/Province

Complete Country Start date End date

/ /

/ /

Language of instruction Status

Pending results

Incomplete

10. English language proficiency*

Refer to the Handbook and Country Profile for specific English Language requirements

Is English your first language? Was English the language of your highest level of study?

Yes

No

If `Yes go to next section. If `No answer the following questions:

Yes

No

If `Yes, provide a statement from the institution verifying the language of instruction.

Have you taken an IELTS or TOEFL test? Test name

Yes

No

Date // Overall test score taken Reading Writing Score Listening Score Speaking Score Score If `No, when do you expect to complete // Tes the test? t

11. Computer literacy* Please answer the following questions to the best of your ability. This will assist Australian institutions to decide whether to provide additional tuition. Are you computer literate? How regularly do you use a PC? Word processing software (e.g. Word)? Database software (e.g. Access)? Presentation software (e.g. PowerPoint)? Internet browsers (e.g. Internet Explorer)?
Monthly

Yes
Occasionally

No
Daily Weekly

Do you have experience with the following software? Yes Yes Yes Yes No No No No Spreadsheet software (e.g. Excel)? Operating systems (e.g. Windows 2000)? Email software (e.g. Outlook)? Statistical packages (e.g. SPSS or Minitab)? Yes Yes Yes Yes No No No No

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

13. 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. Position title Organisation Date commenced / /

Level of position in organisation structure (eg. Position No. 1 being the CEO) Government/public Sector/organisation Private type Current duties and responsibilities (max 500 characters, approx 80-100 words limit)

NGO /civil society

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Current employment

continued

Do you intend to return to this organisation after your scholarship in Australia?* If Yes, how will this scholarship contribute to the organisations human resource development needs? (max 500 characters, approx 80-100 words limit) If No, what are your plans when you finish your studies? (max 500 characters, approx 80-100 words limit)

Yes No

14. 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 Duties/responsibiliti es (max 500 characters, approx 80-100 words limit) / / End date / /

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Previous relevant employment 2. Previous position Position title Start date Organisation Duties/responsibiliti es (max 500 characters, approx 100 words limit) / /

continued

End date

/ /

15. 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?*

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Supporting statement

continued

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

Governance Health, HIV/AIDS, 4. Please indicate the pandemics development theme that Human rights is most relevant to your Infrastructure application.* Regional stability Rural development Water & sanitation 5. Do you currently have any connection or relationship to any staff employed at AusAID Posts or with AusAIDs Yes No managing contractors?*
If `Yes please expand.

Disability Disaster risk reduction Economic growth Education Environment Food security Gender equality

6. Are you subject to any criminal or civil proceedings that are currently awaiting legal action?*

Yes

No

If `Yes please expand. Please note information provided here will not necessarily disqualify you from submitting this scholarship application.

7. 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

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16. Leadership Award (Masters and PhD applicants only) To receive a Leadership Award, you must demonstrate your leadership qualities and potential to influence change. Refer to the Handbook for further details on the supplementary Leadership Award. Do you wish to be considered for a Yes No Leadership Award?*

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, per question. Attach a page if not enough room on this form. Please note the word

1. How have you contributed to solving a challenge? (In your response include: what aspect/s of your leadership knowledge, skills and practice you consider to be well established and effective; which people or organisations you worked with to solve the problem; and, what creative methods were

2. What specific development issue in your country do you plan to work on after 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 key areas of your leadership knowledge, skills and practice you wish to develop. Given the opportunity to develop these areas through a Leadership Award,

4. What is the importance of expanding your professional networks and coalitions in regard to effecting positive change and development in your home country?

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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 (if any) Start date / / 2. Organisation Name

End date

/ /

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

End date

/ /

Highest position held (if any) Start date / / Start date / / End date / /

18. Communication* Where did you first learn of the Australia Awards Development Scholarships? AusAID scholarship Australia Awards AusAID or Managing recipient website Contractors Office Friend, relative or Home institution or AusAID Website colleague university Australian Embassy or Australian institution Publication, Radio, TV Australian Education or university (specify) (specify) Centre (specify location) Workplace or nominating authority (specify) Other (specify)

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19. 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.

> >

ONE COPY of the completed application form. EACH 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 following documents in support of your application.
All applicants: Proof citizenship i.e. birth certificate /passport if available and photographic identification i.e student card drivers licence if passport is not available. IELTS or TOEFL results Statement from university or school that English is the language of instruction Vocational, technical and undergraduate study applicants: Official secondary school results Official English translations of school results Postgraduate study applicants: Official post-secondary and tertiary certificates/degrees Official translations of post-secondary and tertiary certificates/degrees Official post-secondary and tertiary transcripts of results Official translations of post-secondary and tertiary transcripts of results Referee reports Research applicants only: Reports from two academic referees (if not available, please explain why) List of relevant publications Other: Any other relevant documents in support of your application. (Some countries will require other documents. Please refer to the website or seek advice from the relevant AusAID office/Managing Contractor.) Please list: Yes N/A Yes Yes N/A N/A Yes Yes Yes Yes Yes N/A N/A N/A N/A N/A Yes Yes N/A N/A Yes Yes Yes N/A N/A N/A

* Certified: a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notary or other formally recognised authority. If you

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are unsure about who is the appropriate person to certify your documents, you should contact an AusAID officer at the Australian Diplomatic Mission for your country 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 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 education institution(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 institution while studying under 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 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 education institutions, concerning the Australia Awards. 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 Australia Awards. 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 Award 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 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 badly on 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 written reports, publications or publicity associated with the Award.

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

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 / /

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