ALAS 2012 Application Form
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Transcript of 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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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
Under raduate Post raduate
Under raduate Post raduate
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
Start date / / End date / /
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
Start date / / End date / /
Duties/responsibilities(max 500characters, approx80-100 words limit)
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Previous relevant employment continued
2. Previous position
Position title
Start date / / End date / /
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 / / End date / /
2. Organisation Name
Highest position held
Start date / / End date / /
3. Organisation Name
Highest position held
Start date / /
Start date / / End 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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