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Application No: _______________

SELF ASSESSMENT FORM FOR ELIGIBILITY Checklist

YES NO
1.Are you a Pakistani national?
2. Do you have dual nationality?
If yes, please provide details      

3. Do you have permanent residence in Australia or New Zealand?

4. Are you married or engaged to a person who is eligible to hold Australian or New Zealand
citizenship or permanent residence?
5. Have you been selected for any other Government or Foreign Scholarship?
If yes, please provide details      

6. Have you held any foreign scholarship in the 24 months preceding this application?
(24 months are calculated from the date of arrival back in Pakistan to the closing date for receipt of
applications, i.e. 7 May 2010)
ONLY if you have answered Q. 1 “YES” and have answered Q. 2, 3, 4, 5, 6 “NO” continue
7. Are you applying to commence a new course of study in Australia?
8. Will you be able to take up the scholarship in January 2011?
9. Are you applying for one of the priority areas listed in the scholarship advertisement?
If yes, please include priority area      
10. List the names of two preferred courses of study in respective Universities in Australia
First Preference Course & University:      
Second Preference Course & University:      
11. Do you have at least 16 years of education?
12. Which Profile are you applying under?      
(Description on Profiles under which you can apply is available on http://www.adspakistan.com.pk).
13. Will you be older than 45 years on 7 May 2010?
14. Do you have a current (taken after November 2008) IELTS score?
(if available for profile 1,2 & 3 and mandatory 7.0 score with no band less than 6, for profile 4 applicants)
Please provide overall score       and test date      
15. If you are applying for a Masters by research degree, have you attached an outline of the proposed
research project (up to 1000 words)?
Please proceed further only if you have answered Q. 7,8,9,11, 14 & 15 (Q.15 only if applicable) in the affirmative i.e. have ticked “yes” and have answered
Q. 13 in the negative, i.e. have ticked “No”.

FULL NAME       DATE OF BIRTH      

MALE /FEMALE       REGION      

Attach one copy of this form on top of three sets of application forms. Professional presentation of your application is a requirement

APPLICANT CERTIFICATION
I certify that, to the best of my knowledge and belief, all of the information on or attached to this application is true, correct and complete and made in good faith. I
understand that false or fraudulent information on or attached to this application are grounds for disqualification or for terminating the scholarship award once I have begun
studies in Australia. I understand that any information I give may be investigated.

SIGNATURE DATE SIGNED