Australian Development 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 Country’s profile, available on the AusAID Website (see below) or from the AusAID/Managing Contractor’s 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.

> AusAID’s 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.

The closing date is 17 August 2012 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 and seventy five scholarships are expected to be awarded in 2013 for commencement in 2013/2014 including twenty five Australian Leadership Award Scholarships (ALAS). 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 Jakarta may apply directly to the ADS Program Office with the approval of their relevant Kakanwil or Kadinas and approval from Bupati or Governor (or representative) where necessary. Calon Pegawai Negeri Sipil are not eligible to apply. 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 apply 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 apply. 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 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 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 not older 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 61 in Internet based TOEFL). The IELTS or TOEFL result must be current (a test result obtained in 2011 or 2012 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.

> have a Grade Point Average (GPA) of at least 2.75 for awardees with a disability as declared on the ADS
application form. > > > 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) 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, 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 Strengthening the capacity, accountability and responsiveness of legal, democratic and oversight institutions, and improving local government and public financial management. • • • • • • • • • Law, legal and judicial systems Political Science and Government Public administration Public expenditure management Public Sector Reform Environmental Law Anti-corruption Decentralisation Monitoring & Evaluation

Investing in People

Safety and Peace

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. • • • Conflict Resolution Disaster Prevention and Management Transport Safety Transnational Crime Prevention Development Studies International Studies

Australia Indonesia Partnership Priority Fields of Study

• • • • • • • • • • •

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


• •

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candidates must achieve a minimum score of IELTS 6.gov. The final list of awardees is subject to scrutiny and endorsement by AusAID and Government of Indonesia . clarity of study goals. and Aceh) > 85 percent of awards at Masters level and up to 15 percent at Doctorate (PhD) level.au/docs/aipstrategyinfo.State Secretariat. NOTIFICATION OF THE SELECTION RESULT All applicants will be advised whether or not they have been selected for an interview. 4 .g. Where appropriate. key policy makers and targeted candidates in other organizations associated with AusAID activities. notification will include details of pre-departure training (English.NB: If your study area is not listed here. research institute. higher education institutions. This training is compulsory and full-time (see page 7 for step by step of ADS Application Process). Selection Process All applicants are considered by an independent Joint Selection Committee comprised of Australian and Indonesian academics. > an equal number of awards will be offered to men and women. academic skills. medical internships. The interview will assess candidates' academic ability. cultural preparation). Only those shortlisted will be interviewed. Requirements for Scholarship Recipients Prior to travelling to Australia. Successful awardees are expected to complete such training in their own country. West Nusa Tenggara. 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. you may still apply for a field of study related to the work of AusAID in Indonesia. legal articles etc.html Candidates considering study for particular professions should note that ADS does not include the practical training period required for professional registration. scholarship recipients must: > meet the minimum English language requirement of their chosen Australian university (usually IELTS of 6. All interviewed applicants will be notified whether or not they have been awarded an ADS.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. cultural adaptability. Final selection is objective and based on the principles of merit and equity. SELECTION QUOTAS: In the 2012/2013 ADS cycle. Papua. For more information see the Australia Indonesia Partnership Country Strategy at: http://www. West Papua.ausaid. (NB doctoral level study is only open to staff of universities. 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. e.0) > at the completion of EAP training.5 with no band less than 6. (The geographic focus will include East Nusa Tenggara. The result is final and no correspondence will be entered into.indo. The interview will be accompanied by an IELTS test of English language proficiency. 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).

provided where it is deemed essential to assist awardees to pass course subjects. > Establishment Allowance payable into the awardee’s bank account after arrival in Australia > Contribution to Living Expenses (in Australia Stipend) . scholarship recipients 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.awardee only (awardees are required to maintain OSHC for any accompanying family in order to satisfy visa requirements). a debt to the Commonwealth may be activated OR any time spent in Australia may be added to the two year exclusion period.is available to a ‘single’ awardee after the successful completion of the first year of study. If during the two years exclusion period the scholarship recipients return to Australia. 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) > In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee mobilisation. > Reunion Airfare . except for the final year of the ADS. not the visa expire date. Family Entry Awardees can bring their immediate families to Australia at their own cost.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.In Australia. Families are normally permitted to join eight (8) weeks after the awardee's arrival. > Medical examination and x-ray costs in order to comply with Student Visa requirements > AusAID Student Visa and Student Dependant Visa > Outward Airfare (economy. > Homeward Airfare (economy. 5 . subsequent reunion airfare entitlements will be available on an annual basis for the duration of the ADS.one way) from the international airport closest to the Australian university selected for study by the awardee to the airport closest to the awardee’s home location. This does not apply to any deferral period. if their families meet AusAID and immigration requirements. Calculation of the two years exclusion period starts when the scholarships recipients arrive Indonesia.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 . > Fieldwork .one way) from the airport closest to the awardee’s home location to the international airport closest to the Australian university selected for study by the awardee > Overseas Student Health Cover (OSHC) ..

gov.au TOEFL: http://www.gov. Step 3 Applicant selected for interview receives information of interview/ IELTS test date/location.au/scholar Australian Development Scholarship (ADS) Indonesia: http://www.or.au Australian Educational Institutions and courses .ausaid. Step 2 Applicant is notified of the result of selection for interview by December 2012.Useful websites Australia Awards: http://australiaawards.ets.gov.org.australiaawardsindo. Step 4 Applicant attends interview and IELTS test in January 2013.org/toefl The ADS Application Process Step 1 Applicant sends complete ADS application form to Australia Awards Office by 17 August 2012.au/ Australia Awards – Development Scholarships: http://www.studyinaustralia.the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS): http://cricos.au Studying in Australia: http://www.gov.au IELTS: http://www. 6 .ielts.id Visas – Department of Immigration and Citizenship: http://www.immi.gov.deewr. Step 5 Applicant is advised of the result of their ADS application by February 2013.

If you have only one dd/mm/yyyy Gender* Female Male Which country are you living in now?*       Have you applied. gender and country of citizenship. Personal details Provide supporting documentary evidence of your full name.Australian Development Scholarships 2013 Intake Application Form 1. Title* Given name* Family names* Date of birth* Place of birth* (State/province) Mr Dr specify)                     /   /            Mrs Ms Miss Other(Please Enter your family name and other names as shown in your Birth Certificate. date of birth. 3 x 4 cm. or are you intending to apply.*       Yes No Issue date   /   /            Expiry date   /   /      7 . the identification page of your passport or other official identification document issued by your country of citizenship. Passport or other official identification document. * Denotes mandatory field Attach a recent passport size photo.) Passport no. For example. (provide if you have a passport). for permanent residency or citizenship in Australia or New Zealand?* National Identity Number (KTP No.

) Address line 1 Address line 2 Address line 3 Town/City State/Province Country Phone and email Home phone no. your application will not proceed. Contact details Residential address (Please check that your contact details are correct. Email 1 Email 2                                     (Provide at least one contact number. If you cannot be contacted.) Address line 1* Address line 2 Address line 3 Town/City* State/Province* Country*                                     Postal code (if any)       8 . Fax no.2.* Mobile no. (if any)             Current Work address (Please provide your current work address where you can also be contacted.)       Mailing address (Provide details only if this is different to your current residential address. your application will not proceed. Address line 1* Address line 2 Address line 3 Town/City* State/Province* Country*                                     Postal code (if any) The scholarship application takes several months to be finalised. you cannot be contacted.)                         If Postal code (if any)       Work phone no.

3. provide their details even if they will not accompany you to Australia. Provide if child has a passport. A dependent child is the child or stepchild. of yourself or your spouse.*               /   /            dd/mm/yyyy Gender Male Female       Issue date Expiry date   /   /   /   /           Child 2 Family name Given names Date of birth Country of citizenship Passport no. 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 Child 1 Will this child accompany you to Australia?* Yes No Family name Given names Date of birth Country of citizenship Passport no. NB: This Scholarship does not provide financial support for family members accompanying you to Australia. Provide if spouse has a Provide family name and other names as shown in your spouse’s birth certificate. Note that the scholarship does not provide financial support for accompanying dependants. from the Department of Immigration and Given name*       Family       names* Date of birth*   /   /      Passport no. 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. should they live with you in Australia during your scholarship.*       Issue date Expiry date           9 . Spouse details* If you have dependants (spouse and/or children under 18 years of age). You can get information on your responsibilities for your spouse and any dependant children. passport or other official identification document* dd/mm/yyyy       Gende Male Female r* Issue date   /   /      Expiry Date   /   /      Country of citizenship       Will your spouse accompany you to Australia?* Yes No 4. Will this child accompany you to Australia?*               /   /            Yes No dd/mm/yyyy Gende r   /   /   /   / Male Female Provide if child has a passport. who is not married or engaged to be married and has not turned 18 years of age.

Mr Mrs Ms Miss Dr Title* Please Other       specify Relationship Family name*             to 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.Children details continued Child 3 Will this child accompany you to Australia?* No Family name       Given names Date of birth Country of citizenship Passport no. 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) University       No       Country 10 . Emergency contact details* Provide details of a person that can be contacted in case of an emergency. Provide if child has a passport. This may be a relative or a friend.* Yes         /   /            dd/mm/yyyy Gende r   /   /   /   / Male Female       Issue date Expiry date           5.

and the capacity of relevant institutions to provide the assistance. This information is bound by Australian privacy laws and will be disclosed only for the purpose of facilitating an accessible barrier-free learning environment. sensory. intellectual. appropriate assistance. and the presence in the body of disease-causing organisms Yes No If yes. Under the Disability Discrimination Act. Modifications to physical or learning environments. including additional educational supports such as sign interpreters and captioning. in which years? 8. other Institutions may be recommended. 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’. To assess the likely support needs. AusAID will advise the Institution of any special requirements associated with an Awardee so that the Institution can pass these details to the Institution’s Disability Liaison Officer prior to the Awardee arriving oncampus. Yes       Yes       No No Do you identify as having a disability or do you work in a disability-focused organisation?* *Under Australian law.Previous scholarships continued 2. neurological. 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?       9. disability includes physical. Australian education institutions have to provide 'reasonable adjustments' to students with disability to assist access to study. Scholarship/fellowsh Start date Qualification (if applicable) University                   End date             Country 7. learning disabilities. Under Which Category are you applying for an ADS? * 11 . Where an Institution is not able to provide the assistance requested. Disability AusAID strongly encourages applications from people with disability who are otherwise eligible for a Scholarship. may be available depending on the relevant Institution's capacity. physical disfigurement. awardees with a disability/special need must provide details of the disability and/or special need when they accept their offer. psychiatric.

Candidate decide the topic during course) Coursework Research Combination allowed to upgrade your course from the level at which you are first placed). please indicate if your application If “Public”. accountability and responsiveness of legal. and improving local government and public financial Investing in People Safety and Peace Better quality. democratic and oversight institutions. emergencies and vulnerability to disasters. and improving natural resource Democracy Justice and Good Governance Strengthening the capacity.  Identify the Priority Field of Study (PFS) from the list of preferred PFS provided Australia Indonesi a Partners hip Priority Develop Descripti on of PDA Sustainable Growth and Economic Management Improving economic policy and management. reducing constraints to growth in infrastructure and productivity. please indicate if your application is from: is from: Private university Private individual Government Department State-owned Enterprise State University 10. and better health access and systems Improving responses to humanitarian needs. Research background of Doctorate(PhD) candidates only:*   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 Proposed field of study* You are required to:  Identify the priority Development Area (PDA) for your proposed studies. Note that the proposed program of study should be appropriate to your academic qualification and work experience. 12 . access and governance in education.Open Public If “Open”. and improving capacity to ensure transport security and to counter threats from transnational crime. 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. (Please tick one box only). Requested Level of study* (You will not be Masters Doctorate (PhD) Type of study* (Masters coursework program can contain a research project up to 30% of the Masters.

Australia Indonesi a Partners hip Priority Fields of Study (PFS)* Natural Resource Management Agriculture Law. legal and judicial systems Political Science and Government Public administration Public expenditure management Public Sector Reform Environmental Law Anti-corruption 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 Conflict Resolution Disaster Prevention and Management Transport Safety Transnational Crime Prevention Development Studies International Studies Aquaculture/fis heries Forestry Climate Change Economics Infrastructure Planning Water and Sanitation Rural Growth Small and Decentralisatio Other. please specify:       13 .

Proposed study program* continued Have you obtained information from the ADS Information CD.or. 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.Australian Universities List Following Australian universities are under contract to AusAID to provide courses for ADS awardees.       ADS . Preference 1*       14 . Please visit the following website for more details on Australian Educational Institutions and courses .id. You need to decide which Australian university you want to attend and choose an appropriate course. You are encouraged to choose two different Australian universities rather than two different courses at the same university. 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. Awardees are required to find a suitable course of study at one of these Australian universities. you should refer to the individual Australian university websites.deewr. or from the ADS website regarding study options in Australia? Yes No Please describe the efforts you have undertaken so far to obtain information on your study options in Australia. The CRICOS code from your course can be found on the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) Website http://cricos. You should choose two courses of study.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.gov. If your application for the first choice of study is unsuccessful.CRICOS: http://cricos.au To find out about the content of specific courses.deewr. AusAID will forward your application to your second choice.gov. PhD candidates must find a supervisor at one of these universities.adsindonesia.

Course title or particular focus area within your identified proposed Field of CRICOS code (if applicable)*       Australian University (if applicable)       Course duration (weeks) (if applicable)       Minimum English language proficiency required for the course (IELTS) (if       15 .

* CRICOS code (if applicable)*             Australian University (if applicable)       Course duration (weeks) (if applicable)       Minimum English language proficiency required for the course (IELTS) (if       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.g.       16 . legal articles etc. medical internship.Proposed preferences continued Preference 2* Course title or particular focus area within your identified proposed Field of Study. please attach Are there any special subjects or skills development that you would like to include in your choice? Yes No Yes No If "Yes" please give details. Applicants are expected to complete such practical training in their own country). (Note that ADS does not include the practical training period required for professional registration. Have you discussed your proposed course with a member of staff from any Australian university? This is highly recommended for PhD applicants. If “Yes”. e.

000 characters)       Provide a Research Statement (purpose of study) to accompany the proposed research.Research proposal details Complete this section if the studies will be by Research or a combination of Research and Coursework. Answers should be concise but sufficient to explain the nature of your research proposal to the selection panel.300 characters)       17 . 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. Research title       (max 250 characters. approx 30-50 words limit) What is the background to the research being proposed? (maximum 150 words / + 1. Doctorate or Masters by Research.g. Otherwise proceed to next question. E. Please note word limits. Anything over this limit will not be considered.

Research proposal details What is the methodology/struct ure in your proposed research? (include comments on measurements. data sources. (Max 1000 characters.300 characters)       Have you published       any research to date? (include texts. 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)       18 . methods of analysis and timelines) (maximum 200 words / + 1. 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 Yes No Not sure fieldwork?* If `Yes’ please provide a description of the fieldwork you will be undertaking.

starting with the highest. Three certified copies of official transcripts and certificates MUST be included with this application. Technical Postgraduate (S2         /      or Obtained       / Max End date   /   /            Complete Pending results Incomplete 19 . Qualifications* List qualifications (whether complete or not) by level of study. Qualification name Level of study Name of university State/Province Language of instruction GPA (if applicable) Status                   Country* Start date *         /   /      Postgraduate (S2 or Obtained       / Max End date*   /   /            Complete Pending results Incomplete       Secondary (High School) ( DIII or DIV ) Undergraduate (S1)                   Obtained       / Max       Complete       Secondary (High School) ( DIII or DIV ) Undergraduate (S1)                   Country Start date   / Vocational. Applicants are required to fill out the total GPA obtained and the maximum GPA possible for each qualification noted below. Qualification       name* Secondary (High School) Vocational. If you have not completed your studies please list your anticipated end date. Technical Postgraduate (S2         /   /   /   /           or Country* Start date* End date* Pending results Incomplete Vocational. Qualification name* Level of study* Name of university* State/Province Language of instruction* GPA (if applicable) Status 3.11. you MUST provide certified English 1. Technical ( DIII or DIV ) Level of study* Undergraduate (S1) Name of university* State/Province Language of instruction* GPA (if applicable) Status 2. If you are selected for interview.

g.g. Course name 1 Start date Course name 2 Start date         /   /              /   /      End date   /   /      End date   /   /      20 . SPSS or Minitab)? Yes No Yes No Yes No Yes No Yes No Yes No Yes No 14. Access)? Presentation software (e.g. The IELTS or TOEFL (Institutional or International) result must be current (a test result obtained in 2011 or 2012 will be considered current).g. NO other English language test (including TOEFL prediction) Is English your first language? Yes No If `Yes’ go to next section. IELTS or test TOEFL) taken Test Phone       Centre/location If `No’. Internet Explorer)? Yes No Spreadsheet software (e.g. provide a statement from the university verifying the language of instruction. Outlook)? Statistical packages (e.g. Excel)? Operating systems (e. Are you computer literate?* How regularly do you use a PC?* Monthly Yes Occasionally No Daily Weekly Do you have experience with the following software?* Word processing software (e.g.12.0 in IELTS (or 500 in paper-based TOEFL or 61 in internet-based TOEFL). PowerPoint)? Internet browsers (e. Computer literacy* Yes No If `Yes’. when do you expect to complete the test? 13.g. Word)? Database software (e. Yes      /     /             No Overall score Website Test name                        /     /      Please answer the following questions to the best of your ability. Windows 2000)? Email software (e. English language proficiency* Applicant must have an English language proficiency of at least 5. An original copy of your IELTS or TOEFL certificate must be attached to the application form. This will assist Australian universities to decide whether to provide additional tuition.g. If `No’ answer the following questions: Was English the language of your highest level of study? Have you taken an IELTS or TOEFL test? Test name Date       (e. Computer training details List any formal computer courses you have undertaken.

approx 80-100 words limit) Yes No 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)       21 . Current employment Current employment may include work experience and voluntary work. Position title*       Organisation* Level of position in organisation structure (eg. what role       and responsibilities do you expect to undertake after your academic studies? (max 500 characters. Echelon and Golongan) Sector/organisation type Briefly describe the work of your organisation and the service it provides.             Date commenced*   /   /      Government/Public Private       NGO /Civil Society Briefly describe your       current duties and responsibilities (max 500 characters. Please enter ‘Not Applicable’ in the ‘Position Title’ if you are not currently employed.15. You must provide a current CV. approx 80-100 words limit) Do you intend to return to this organisation after your scholarship in Australia?* If ‘Yes’.

) Jakarta Yogyakarta Surabaya Denpasar Balikpapan/Banjarmasin Jayapura Medan Padang Makassar Manado Kupang 22 . Previous position Position title Start date Organisation Duties/responsibiliti es (max 500 characters. 1. (Please note Your choice is not guaranteed. approx 100 words limit)         /   /                  End date   /   /      17. Interview Centre * Please tick your preferred interview center. approx 80-100 words limit)               /   /            End date   /   /      2. Employment history should also include work experience. Previous relevant employment Only provide previous employment that is relevant to your application. community work and voluntary work. Previous position Position title Organisation Start date Duties/responsibilitie s (max 500 characters.16.

1. Attach a page if not enough room on this form. Please note word limits.)?*       23 . Anything over this limit will not be considered. per question. approx 80-100 words. which people or organisations you worked with to solve the problem. skills and practice you consider to be well established and effective. What skills and knowledge do you hope to gain and how do you propose to use them?*       3. Supporting statement Limit your answers to 500 characters. Why do you want to study in Australia?*       2. and what creative methods were used.18. 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.

What specific development priority will you contribute to on your return home and how do you intend to do so?*       5.       Yes No Yes No 7. Do you wish to be considered for a supplementary Leadership Award? Refer to the Handbook for further details on the supplementary 6.       24 . Please note information provided here will not necessarily disqualify you from submitting this scholarship application.Supporting statement continued 4. Do you currently have any connection or relationship to any staff employed at AusAID Posts or with AusAID’s managing contractors?* If `Yes’ please expand. Are you subject to any criminal or civil proceedings that are currently awaiting legal action?*to live and Yes No If `Yes’ please expand.

Communication* Where did you first learn of the Australian Development Scholarships? (tick box and specify where asked to do so) AusAID scholarship recipient Friend.19. relative or colleague Australian Embassy or Australian Education Centre (specify location)       Workplace or nominating authority (specify)       asked to do so) Australia Awards website AusAID Website Australian institution or university (specify) AusAID or Managing Contractor’s Office Home institution or university Publication. Organisation Name       Highest position held (if       any) Start date   /   /      2. scientific. relative or colleague Education Agent (specify) ADS Office DEEWR Office Home institution or university (specify)       Other (specify) AusAID Office GoI State Secretariat Office AusAID project office (specify)       Workplace or nominating authority (specify)                   25 . professional and/or educational associations and organisations. Organisation Name       End date   /   /      Highest position held (if       any) Start date   /   /      Start date   /   /      End date   /   /      20. Professional memberships Professional memberships may include community. political. Radio. 1. TV (specify)             Other (specify)       From where did you obtain your application form? (tick box and specify where ADS website Friend. cultural. Organisation Name       End date   /   /      Highest position held (if       any) Start date   /   /      3.

Public Notary or other formally recognised authority.  At least one copy of the application form should have certified* copies attached of the relevant documents listed below. 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).e. All applicants: (Essential) You MUST include all the essential documents. * Certified: a statement that the document is a true copy. TOEFL prediction test is NOT accepted.  Where original documents are not in English. Yes Yes Yes Yes Yes Yes Yes N/A N/A N/A N/A N/A N/A N/A 26 . you must provide certified* copies of official English translations if you are selected for an interview. signed by a Commissioner of Oaths. Required documentation: please tick if you have attached the following documents in support of your application. Checklist of documentary evidence* Please note: You are responsible for providing all supporting documents are provided. copies of birth certificate or equivalent proof citizenship i.  THREE COPIES of the completed application form. 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 2011 or 2012 will be considered current). you should contact the ADS Office. your application will be automatically rejected. 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 Yes Yes Yes Yes Yes Yes N/A N/A N/A N/A N/A N/A Yes Yes Yes Yes N/A N/A N/A N/A 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. If you are unsure about who is the appropriate person to certify your documents. If at least one essential document is not provided.21. If you do not provide all required documents your application will be rejected.

DO NOT attach original documents.official (certified*) English translations of birth certificate Yes N/A IMPORTANT: • Attach only certified copies of documents. • Application forms and documents will not be returned. 27 .

complete their ADS award within the period stipulated in their Student Contract. 23 and 24 you are strongly advised to seek clarification of these conditions from the Australia Awards Office. DO NOT sign the declaration at the end of section 23 and 24 until you fully understand the conditions of the scholarship award. not hold another Australian Government scholarship at the same time as the ADS. or if they apply for Permanent Residence or for a visa to remain in or return to Australia within the two year period. If you have any problems understanding Section 22. if they marry a person who is an Australian or New Zealand citizen. Conditions of Scholarships WARNING: In section 22. advise AusAID immediately. agree to AusAID collecting information concerning the Student or dependants and passing that information on to other relevant parties. maintain an appropriate study load and achieve satisfactory academic progress in the program for which the ADS was offered. or who has permanent residence status in Australia or New Zealand. and the university’s compulsory Introductory Academic Program (IAP) on arrival 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. including all lectures and tutorials. assignments or essays) and sit for examinations. participate in the Pre-Departure Briefing arranged by the Post. AusAID and Partner Government before any changes are made..22. participate in all activities associated with the approved course of study. In accepting an Australian Development Scholarship. submit all work required for the course (e. reunion visits or fieldwork visits to their home country). only undertake the approved program for which the ADS is offered and abide by the rules of the university. 23 and 24 you will be agreeing to important conditions attached to your award and your study in Australia. The main conditions are set out below for your information. be aware that any employment undertaken during term times may compromise academic progress.g. via the Student Contact Officer at the university. reside in Australia for the duration of the ADS (apart from holidays. return to their country of citizenship for two years at the completion of their study/research program in Australia. if necessary. The change in a student’s 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. 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. complete a full study program during the course of their scholarship. you will be asked to: • • • take up the ADS in the academic year for which it is offered. and 28 • • • • • • • • • • • • • . not undertake any additional off-scholarship tertiary studies during their time in Australia on an AusAID Student Visa. If you are offered a scholarship you will be asked to agree to certain conditions before accepting the scholarship. 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.

This does not apply to any deferral period. 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.• • that any time spent in Australia during the two year return home period will accordingly extend the end date of the two year period. (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) In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee mobilisation. misconduct. Medical examination and x-ray costs in order to comply with Student Visa requirements 29 . agree that their ADS may be terminated at any time for failure to make satisfactory academic progress. Conditions of Scholarships continued Subject to your fulfilling these conditions AusAID will provide the following. failure to comply with the laws of Australia.

• • • • • • • • • • AusAID Student Visa and Student Dependant Visa Outward Airfare (economy. Establishment Allowance payable into the awardee’s bank account after arrival in Australia Contribution to Living Expenses (in Australia Stipend) .required for Public sector applicants only* 30 .is available to a ‘single’ awardee after the successful completion of the first year of study. 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 .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. Nominating Agency Declaration . subsequent reunion airfare entitlements will be available on an annual basis for the duration of the ADS.one way) from the airport closest to the awardee’s home location to the international airport closest to the Australian university selected for study by the awardee Overseas Student Health Cover (OSHC) . 23.awardee only (awardees are required to maintain OSHC for any accompanying family in order to satisfy visa requirements). Homeward Airfare (economy. Fieldwork .provided where it is deemed essential to assist awardees to pass course subjects. Reunion Airfare . except for the final year of the ADS.one way) from the international airport closest to the Australian university selected for study by the awardee to the airport closest to the awardee’s home location. • 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.payment of a fortnightly contribution to living expenses (CLE).

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. Echelon and Golongan)                         Date commenced   /   /      How long have you known the applicant and in what capacity?       Please make any additional comments about the applicant's potential or personal qualities which you feel would be helpful to the ADS Selection Team. This training is full-time and compulsory to release the applicant from work duties after English for academic training to study in Australia. Name of Ministry/Employer Name of Applicant Applicant’s Position title Applicant’s Level of position in organisation structure (eg. I the undersigned.) 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. 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.(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. agree to be bound to the above commitments and strategies Full Name       Signature & stamp Position Email Mobile                   31       . 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.       Ministry/Agency Representative signature* On behalf of the ministry. • Please also note that if the application is for Doctorate level study. 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.

• Agreement If successful in gaining an Australia Development Scholarships. that the information contained in it and provided in connection with it is true and correct. leadership skills and my proposed study program in Australia) in promotional material in hardcopy and on the Internet. media releases and information circulated to AusAID’s offshore Posts and Australian universities.Date    /   /      24. By submitting this form I authorise AusAID. Applicant’s authorisation. or its appointed managing contractor. 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. Declaration and acknowledgement I declare. Ministers and members of Parliament. I note that promotional material may include. in submitting this application form. 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. I acknowledge that giving false or misleading information is a serious offence under the Criminal Code Act 1995 of the Commonwealth of Australia. 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. but is not limited to. Should I receive an Australia Award. Full Name Signature Date 32 . I consent to the Australian Government using and disclosing extracts of my application (relating to my academic background and achievements. to access and/or obtain information. publications or publicity associated with the Scholarships. declaration and signature* Authorisation AusAID must comply with the Privacy Act 1988 in relation to the personal information you have provided in this form. concerning the Australian Development Scholarships. 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.

I endorse the applicant for an Australian Development Scholarship. Ministry of State Secretariat of the Republic of Indonesia use only Endorsement by the Government of Indonesia ( To be completed by Head. field of study and length of award proposed in this application are appropriate and in accordance with the Government's training policy. Name of certifying officer Title Organisation Official Stamp                   Signature Date    /   /                  33 . I certify that the maximum level of study. I certify that I have examined the documents attached to this form and am satisfied that they are authentic and relate to the applicant. Bureau of Technical Cooperation.               /   /      25. Ministry of State Secretariat of the Republic of Indonesia ) On behalf of the Government of Indonesia.