Professional Documents
Culture Documents
Australian Development Scholarships: 2013 Intake Application Form Instructions
Australian Development Scholarships: 2013 Intake Application Form Instructions
Scholarships
2013 Intake Application Form
Instructions
Please print neatly 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 17 August 2012 at the
Australia Awards Office at Gedung Wirausaha, 7th 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 only 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 page 6 Useful Websites).
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
25 - 26) 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.
1
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 have obtained an academic qualification outside their home country in the 24 months preceding the
application closing date, calculated from the date of arrival back in the home country
not be applying for another long-term AusAID scholarship unless they have returned to their home
country and resided there for twice the length of the total time that they were in Australia (for example, a
previous AusAID Scholar who has been on AusAID scholarship/s in Australia for five years will not be
eligible to apply for another AusAID scholarship until they have been home for ten years)
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 satisfy all requirements of the Department of Immigration and Citizenship (DIAC) for an AusAID student
visa and
2
be able to satisfy the admission requirements of the Australian university at which the Scholarship is to be
undertaken.
be applying for courses that fall within the areas of development priority (see Choosing a Course of Study
below)
have a Grade Point Average (GPA) of at least 2.75 for awardees with a disability as declared on the ADS
application form.
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
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.
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
Investing in People
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public
financial management.
Improving responses to
humanitarian needs,
emergencies and
vulnerability to
disasters, and
improving capacity to
ensure transport
security and to counter
threats from
transnational crime.
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
Conflict Resolution
Disaster
Prevention and
Management
Transport Safety
Transnational
Crime Prevention
Development
Studies
International
Studies
NB:
Childhood Special
Education
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
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 Joint 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 2012/2013 ADS cycle, up to four hundred and seventy five (475) ADS scholarships are available for
commencement in 2013/2014 including twenty five (25) Australian Leadership Award Scholarships (ALAS). The
scholarships are allocated as follows:
85 percent of awards at Masters level and up to 15 percent at Doctorate (PhD) level. (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.
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
abide by the conditions of the scholarship and the rules of Australian tertiary institutions
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.
In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee
mobilisation. This does not apply to any deferral period.
Medical examination and x-ray costs in order to comply with Student Visa requirements
AusAID Student Visa and Student Dependant Visa
Outward Airfare (economy- one way) from the airport closest to the awardees home location to the international
airport closest to the Australian university selected for study by the awardee
Overseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for any
accompanying family in order to satisfy visa requirements).
Establishment Allowance payable into the awardees bank account after arrival in Australia
Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to living expenses
(CLE).
Introductory Academic Program (IAP) for a period of 4-6 weeks undertaken prior to the commencement of
Masters or PhD studies
Masters OR PhD Tuition Fees including all compulsory fees for the course in which the awardee is accepted
into
Supplementary Academic Support - provided where it is deemed essential to assist awardees to pass course
subjects.
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.
Homeward Airfare (economy- one way) from the international airport closest to the Australian university selected
for study by the awardee to the airport closest to the awardees home location..
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.australiaawardsindo.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
Step 2
Applicant is notified of
the result of selection for
interview by December 2012.
Step 3
Applicant selected for
interview receives
information of interview/
IELTS test date/location.
Step 4
Applicant attends
interview and IELTS test
in January 2013.
Step 5
Applicant is advised of
the result of their ADS
application by February 2013.
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.
Attach a recent
passport size photo.
3 x 4 cm.
Title*
Mr
Mrs
Other(Please specify)
Given name*
Family names*
Date of birth*
/ /
Ms
Miss
Dr
Gender*
Female
Male
Yes
No
Issue date / /
Expiry date / /
2. Contact details
Residential address (Please check that your contact details are correct.
Address line 1*
Address line 2
Address line 3
Town/City*
State/Province*
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
Country
Mobile no.
Email 1
Email 2
Current Work address (Please provide your current work address where you can also be contacted.
Address line 1*
Address line 2
Address line 3
Town/City*
State/Province*
Country*
10
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*
Family names*
Date of birth*
/ /
Passport no.
Provide if spouse
has a passport.*
Country of
citizenship
dd/mm/yyyy
Gender*
Issue date
Male
/
Female
Expiry Date / /
Yes
No
Family name
Given names
Date of birth
/ /
Country of citizenship
Passport no.
Provide if child has a
passport.*
Child 2
dd/mm/yyyy
Family name
Given names
Date of birth
/ /
Country of citizenship
Passport no.
Provide if child has a
passport.*
Yes
No
Gender
Issue date
Expiry date
Yes
dd/mm/yyyy
Male
Female
Male
Female
No
Gender
Issue date
Expiry date
11
Family name
Given names
Date of birth
/ /
Country of citizenship
Passport no.
No
dd/mm/yyyy
Yes
Gender
Male
Issue date
Expiry date
Female
Title*
Mrs
Other
Please specify
Ms
Miss
Dr
Family name*
Relationship to
you*
Given name*
Gender*
Home phone*
Work phone
Mobile phone
Email 1
Email 2
Address line 1*
Address line 2
Address line 3
Town/City*
State/Province*
Country*
Male
Female
No
End date
University
Country
Country
12
Start date
University
Country
End date
7. Scholarship applications
Have you previously applied for an AusAID scholarship but were
unsuccessful?*
No
Yes
If "Yes" how many times have you previously applied for ADS?
Have you previously been interviewed by ADS?*
No
Yes
AusAID strongly encourages applications from people with disability who are otherwise eligible for a Scholarship. Under the Disability
Discrimination Act, Australian education institutions have to provide 'reasonable adjustments' to students with disability to assist access to study.
To assess the likely support needs, appropriate assistance, and the capacity of relevant institutions to provide the assistance, awardees with a
disability/special need must provide details of the disability and/or special need when they accept their offer. This information is bound by
Australian privacy laws and will be disclosed only for the purpose of facilitating an accessible barrier-free learning environment.
Modifications to physical or learning environments, including additional educational supports such as sign interpreters and captioning, may be
available depending on the relevant Institution's capacity. AusAID will advise the Institution of any special requirements associated with an
Awardee so that the Institution can pass these details to the Institutions Disability Liaison Officer prior to the Awardee arriving on-campus.
Where an Institution is not able to provide the assistance requested, other Institutions may be recommended.
No
Yes
If yes, please provide details if you require special assistance or equipment to participate in the Scholarship selection
processes or to live and undertake studies in Australia?
Public
Private university
Government Department
Private individual
State-owned Enterprise
State University
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
Masters
Doctorate (PhD)
Coursework
Research
Combination
Do you hold a Masters degree with > 50% weighting for research?
Yes
No
Are you including a letter from your Masters supervisor recommending that you should pursue Doctorate
studies? (Recommended) Yes
No
Australia
Indonesia
Partnership
Priority
Fields of
Study (PFS)*
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.
Natural Resource
Management
Agriculture
Aquaculture/fisheries
Forestry
Climate Change
Economics
Infrastructure
Planning
Water and Sanitation
Rural Growth
Small and medium
enterprise
development
Democracy Justice
and Good
Governance
Investing in People
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public
financial management.
Improving responses to
humanitarian needs,
emergencies and vulnerability
to disasters, and improving
capacity to ensure transport
security and to counter
threats from transnational
crime.
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
14
No
Yes
Please describe the efforts you have undertaken so far to obtain information on your study options in Australia.
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.*
Australian University
Minimum English
language proficiency
required for the course
(IELTS) (if applicable)
(if applicable)
15
Australian University
Minimum English
language proficiency
required for the course
(IELTS) (if applicable)
(if applicable)
No
Yes
No
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).
16
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)
17
Yes
No
Not sure
If `Yes please provide a description of the fieldwork you will be undertaking. (Max 1000 characters, approx 200 words
limit).
Weeks
18
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*
Vocational, Technical
( DIII
or DIV )
Undergraduate (S1)
Postgraduate (S2
Level of study*
Name of university*
State/Province
Language of instruction*
Start date * / /
Obtained / Max
End date*
Status
2. Qualification name*
Complete
Pending results
or S3
Incomplete
Vocational, Technical
( DIII
or DIV )
Undergraduate (S1)
Postgraduate (S2
State/Province
Language of instruction*
Start date*
Obtained / Max
End date*
Complete
Country*
/
/
Pending results
/
/
Incomplete
Vocational, Technical
( DIII
or DIV )
Undergraduate (S1)
Postgraduate (S2
Level of study
Name of university
State/Province
Language of instruction
Start date
Obtained / Max
End date
Status
or S3
Name of university*
3. Qualification name
Country*
Level of study*
Status
or S3
Complete
Country
Pending results
Incomplete
19
Yes
No
Yes
No
Yes
No
Date test //
taken
Overall
score
Test Centre/location
Phone
Website
Test name
//
Yes
Occasionally
No
Daily
Weekly
Monthly
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Start date
/ /
Course name 2
Start date
/ /
End date
/ /
End date
/ /
Position title*
Organisation*
Level of position in
organisation structure
(eg. Echelon and Golongan)
Sector/organisation type
Government/Public
Date commenced*
NGO /Civil Society
/ /
Private
Yes
No
21
Organisation
Start date
/ /
Duties/responsibilities
(max 500 characters,
approx 80-100 words limit)
End date
/ /
End date
/ /
2. Previous position
Position title
Start date
/ /
Organisation
Duties/responsibilities
(max 500 characters,
approx 100 words limit)
Medan
Makassar
Yogyakarta
Padang
Manado
Surabaya
Balikpapan/Banjarmasin
Kupang
Denpasar
Jayapura
22
2. What skills and knowledge do you hope to gain and how do you propose to use them?*
3. How have you contributed to solving a challenge and to implementing change or reform? (Be specific and
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
used.)?*
23
Yes
No
Yes
No
Yes
No
7. Are you subject to any criminal or civil proceedings that are currently awaiting
legal action?*to live and undertake studies in Australia?)
If `Yes please expand. Please note information provided here will not necessarily disqualify you from submitting this scholarship application.
24
Start date
/ /
2. Organisation Name
Start date
/ /
3. Organisation Name
Start date
/ /
Start date
/ /
End date
/ /
End date
/ /
End date
/ /
20. Communication*
Where did you first learn of the Australian Development Scholarships?
(tick box and specify where asked to do so)
AusAID or Managing
Contractors Office
AusAID Website
Australian Embassy or
Australian Education Centre
Australian institution or
university
Publication, Radio, TV
(specify location)
(specify)
(specify)
Other
(specify)
(specify)
From where did you obtain your application form? (tick box and specify where asked to do so)
ADS website
ADS Office
AusAID Office
DEEWR Office
(specify)
(specify)
Other
(specify)
(specify)
25
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
current (original) IELTS or TOEFL English language test results (a test result obtained
in 2011 or 2012 will be considered current). TOEFL prediction test is NOT
Yes
N/A
Masters applicants must also attach certified DIII degree certificate/transcript if using
DIV or S1 extension certificate/transcript
Yes
N/A
Yes
N/A
Yes
N/A
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
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
accepted.
IMPORTANT:
Attach only certified copies of documents. DO NOT attach original documents.
Application forms and documents will not be returned.
26
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.
27
Pre-Course English provision of English for Academic Purposes training prior to commencement of studies in
Australia (including an in-Indonesia stipend)
In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee
mobilisation. This does not apply to any deferral period.
Medical examination and x-ray costs in order to comply with Student Visa requirements
Outward Airfare (economy- one way) from the airport closest to the awardees home location to the international
airport closest to the Australian university selected for study by the awardee
Overseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for any
accompanying family in order to satisfy visa requirements).
Establishment Allowance payable into the awardees bank account after arrival in Australia
Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to living
expenses (CLE).
Introductory Academic Program (IAP) for a period of 4-6 weeks undertaken prior to the commencement of
Masters or PhD studies
Masters OR PhD Tuition Fees including all compulsory fees for the course in which the awardee is accepted
into
Supplementary Academic Support - provided where it is deemed essential to assist awardees to pass course
subjects.
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.
Reunion Airfare - is available to a single awardee 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.
Homeward Airfare (economy- one way) from the international airport closest to the Australian university
selected for study by the awardee to the airport closest to the awardees home location.
appropriate academic and welfare support for the duration of your studies
23. Nominating Agency Declaration - required for Public sector applicants only*
28
(NB: to be completed by the staff member within your organisation authorised to release staff for overseas study - for
example staff from the International Relations Bureau (BKLN) / Centre for Education and Training / the Planning Bureau /
Rector from the university as appropriate. Applicants from outside Jakarta must have the approval and nomination of their
relevant Kakanwil or Kadinas and approval from Bupati or Governor (or representative) where necessary.)
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 fulltime 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
Date commenced
/ /
Position
Mobile
Date
/ /
29
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:
to monitor my academic performance at my host university while studying under an Australian Development
Scholarships
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:
immediately provide AusAID with details of any incident that may reflect badly on the prestige of an Australia
Development Scholarships
acknowledge the assistance given by the Australian Government in any written reports, publications or publicity
associated with the Scholarships.
Signature
Date
/ /
30
Title
Organisation
Official Stamp
Signature
Date
/ /
31