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Application-2015 Example PDF
Application-2015 Example PDF
Please ensure that you have read the Endeavour Scholarships and Fellowships applicant guidelines available on the website
before completing this form. Return your application forms and the required supporting documentation to us at:
Endeavour Management Team
Australian Government Department of Education
International Group, GPO Box 9880
Canberra ACT 2601, AUSTRALIA
Incomplete or late applications will not be accepted
1. PERSONAL DETAILS
Title: Mr
Gender:
Male
Female
Preferred Name:
Former Name:
Yes
No
No
Language Japanese
Disability
Yes
Postal Address
Residential Address
(where you are currently living)
Address Line 1:
Address Line 2:
Address Line 2:
City/Suburb: Sendai
City/Suburb:
State/Province: Miyagi
State/Province:
Country: Japan
Postcode: 980-0856
Type
Postcode:
Country:
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Country of Citizenship
Japan
Japan
Yes
Country(ies)
Canada
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Australia
Please note, applicants must not choose a host country or part of a country that has been assessed by the Department of Foreign Affairs and
Trade (DFAT) as an area not to travel (Level 4). Further information is available at www.dfat.gov.au.
3. PROPOSED PROGRAMME
Please indicate the Endeavour Scholarship or Fellowship you are applying for and the type of activity you would like to undertake:
1. Endeavour Postgraduate Scholarship (non-Australian)
Professional Development
Diploma
Advanced Diploma
Associate Degree
3. Endeavour Research Fellowship (including Indigenous Fellowships)
Engineering
Proposed host institution/organisation: (If more than one, please list in order of preference)
1. Monash University
2. The University of Sydney
3. The Australian National University
Proposed Start Date:
01/02/2015
Home institution/organisation
Tohoku University
Japan
Applicants applying for an Endeavour Postgraduate Scholarship (non-Australian) or Endeavour VET Scholarship require an admission letter (letter
of offer) from an Australian university/institution.
Applicants applying for an Endeavour Research Fellowship (including QE II and Indigenous Fellowships), Endeavour Executive Fellowship or
Endeavour Postgraduate Scholarship (Australian) require an Endeavour Scholarships and Fellowships nomination form to be completed by their
proposed host.
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Summary of Programme: Please summarise, in words that can be understood by a person outside your field, what your proposed
programme is intended to achieve, why you would like to undertake the proposed programme and how it is related to your prior experience
and/or future career goals. Please also provide details, including proposed dates and locations, of any proposed fieldwork and/or internships
(maximum 300 words).
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4. EDUCATIONAL QUALIFICATIONS
Please provide details of your educational qualifications:
Please attach a separate list if you have completed more than three qualifications.
Qualification: PhD
Institution: Tohoku University
Country of enrolment: Japan
Start and end years: 2012 - 2016
Study Status:
Completed
On-going
Completed
On-going
Completed
On-going
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5. LANGUAGE REQUIREMENTS/PROFICIENCY
Endeavour Postgraduate Scholarship (non-Australian) and Vocational Educational Training Scholarship applicants must provide (a) or (b):
(a)
IELTS/TOEFL A certified copy of an official, valid IELTS or TOEFL test result. Results are valid for two years. Tests that are provided with
a test date that is before 30 June 2012 will not be accepted and the application will be marked ineligible. Test scores will need to meet the
minimum requirements (see table below);
Test Type
Prime
TOEFL Computer Based Test (CBT) Score of 230 including an Essay Rating score of 4.5
TOEFL Internet Based Test (IBT)
(b)
Overall score of 90 with a minimum score of 22 in the writing section and no less than 20 in the other sections
A certified copy of an academic transcript as proof of completion of one full year of University level study minimum conducted in English in
(not by correspondence) one of the following listed countries*
American Samoa, Australia, Botswana, Canada, Fiji, Ghana, Guyana, Ireland, Jamaica, Kenya, Lesotho, Liberia, New Zealand, Nigeria,
Papua New Guinea, Singapore, Solomon Islands, South Africa, Tonga, Trinidad and Tobago, United Kingdom (including Northern Ireland),
United States of America, Zambia or Zimbabwe.
* This list is determined by the Universities Admissions Centre (UAC) and is part of a collective agreement with Australian Universities.
All Endeavour Research Fellowship, Endeavour Executive Fellowship and Endeavour Queen Elizabeth Diamond Jubilee Scholarship
applicants must provide:
At least one completed nomination from their host organisation to undertake their programme in 2015
Your host organisation must confirm via the nomination form that your language ability is suitable for your proposed programme. If they do not
confirm this, you will be ineligible and your application will not be considered further.
Institution
Country
Year Awarded
University Medalist
Canada
2009
President's Scholarship
Hitotsubashi University
Japan
2010
Merit Scholarship
Hitotsubashi University
Japan
2011
Memberships
Membership
Country
Membership type
Japan
Member
Japan
Executive Member
Publications
Author(s): J. Suzuki
Publication title: A guide to modern engineering
Publisher/Journal title: Engineers Monthly
Language of Publication: Japanese
Year of Publication: 2010
Author(s): J. Suzuki, B. Ishida, H. Johnstone
Publication title: Advanced theories in modern engineering
Publisher/Journal title: Engineers Digest
Language of Publication: English
Year of Publication: 2014
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Please provide details of relevant employment history beginning with your current or most recent employment.
Job Title
Employer Name
Country of Employment Start month and year End month and year
Japan
01/02/2014
Current
Project Manager
Japan
03/03/2010
30/01/2014
Administrate Assistant
Canada
03/05/2008
30/11/2009
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8. REFEREES
Please provide details of two referees. It is your responsibility to ensure that referee reports are received by the Department by the closing
date.
Title: Ms
9. HOST NOMINATION
To be completed by Endeavour Executive Fellowship and Endeavour Research Fellowship (including QE II and Indigenous Fellowship)
applicants only
Title: Mr
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Please provide details of how your proposed programme will benefit Australia and your potential to foster ongoing collaboration and
cooperation with your home and host country/region (maximum 200 words).
Please provide details and evidence of your service to the community, unpaid service within your field of expertise, or unpaid
community service in outside capacities (maximum 200 words).
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Please refer to the Applicant Guidelines to ensure that your supporting documents meet the Scholarship and Fellowship requirements.
Please note that your supporting documents must be in English (approved translations accepted) and where stated must be certified/
attested by an approved authority.
To be eligible, applicants must:
Provide the supporting documentation specified for the category for which they are applying (see applicant guidelines for further
information)
Provide an English translation if the original document is not in English
Applications that do not contain the necessary documentation will be deemed incomplete and therefore ineligible and will not be
considered further
Applicants must provide certified (attested) copies of:
Prime
Citizenship
Permanent residency (if applicable)
Academic transcripts
Language proficiency (IELTS or TOEFL results)
To certify a document as a true copy, applicants should provide the original and a copy of the document to a formallyrecognised
authority. This could include but is not limited to; Justice of the Peace, Commissioner of Oaths, Public Notary, Lawyer, Doctor, Civil
Servant, Teacher, work supervisor, university Dean or course convener. The cost of any fees charged bynotaries for certification of
documents is the responsibility of the applicant.
The certifier should:
1. Sight the original against the copy of the document
2. Write or use a stamp (if available), I certify that the copy is a true copy of the original document
3. Sign under the statement and provide details of their occupation.
Postgraduate
Academic transcripts
Research Fellowship
(including QEII &
Indigenous*)
Executive Fellowship
Research Fellowship
Australians
Executive Fellowship
VET
Required Documents
Postgraduate
Non-Australians
Notice:
The information contained in this email message and any attached files may be confidential information, and may also be the subject of legal
professional privilege. If you are not the intended recipient any use, disclosure or copying of this email is unauthorised. If you received this email in
error, please notify the sender by contacting the departments switchboard on 13 33 97 during business hours (8am - 5pm Local time) and delete all
copies of this transmission together with any attachments.
*Australian applicants applying for an Endeavour Research Fellowship for Indigenous Australians only
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I declare that I have read and understood the Privacy Notice above.
I declare that I have read and understood the Authorisation and
Agreement Statement above
I declare that the contents of my application are true, and
I acknowledge that giving false or misleading information is a
serious offence under the Criminal Code (Commonwealth)
Signature
Date (dd/mm/yyyy)
John Suzuji
05/05/2015
PRINT FORM
* By typing your name into this box, it is considered that you have signed this form and all the information is true and correct
(An electronic signature is not required).
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