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SELF ASSESSMENT FORM FOR ELIGIBILITY
Which Scholarship you are applying for?
(Description on type of scholarships is available on http://www.adspakistan.com.pk ). You can choose
Australian Development Scholarship
Australia Pakistan Agriculture Scholarships
Which Profile are you applying under?
(Description on Profiles under which you can apply is available on http://www.adspakistan.com.pk ).
Do you also want to be considered for a supplementary Australian Leadership Awards (ALA) Scholarship? (Details on ALA is available on
Checklist YES NO
1. 2. 3. 4. 5.
Are you a Pakistani national? Do you have permanent residence in Australia or New Zealand? Are you married or engaged to a person who is eligible to hold Australian or New Zealand citizenship or permanent residence? Have you been selected for any other government or foreign scholarship? Have you held any foreign scholarship within 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 application, i.e. 6th April 2012)
ONLY if you have answered Q. 1 “YES” and have answered Q. 2, 3, 4 and 5 “NO”, please continue 6. Are you applying for a Master level course to study in Australia? 7. Will you be able to take up the scholarship in January 2013? 8. What priority sector, listed in the scholarship advertisement, are you applying for? ______ 9. Do you have at least 16 years of education? 1 Do you have at least two years of work experience after your16 years of 0. education? 1 If you are applying for a Masters by research degree, have you attached an outline 1. of the proposed research project (up to 1000 words)? 1 Will you be 45 years or older on 6 April 2012? 2. Please proceed with main Application Form only if you have answered “YES” for Qs. 6, 7, 8, 9, 10 & 11 and, “No” for Q. 12. 1 Do you have a current IELTS score (test taken after 31st Jan 2011)? 3. (For Profile 4 Candidates, IELTS score of 7 with no band less than 6 is a mandatory requirement for application.
Profile 1,2 & 3 candidates, may provide if available - IELTS score of 6.5 with no band less than 6.0)
1 4. 1
Please provide overall score and test date Are you living with a disability or working for people living with disabilities? Gender Female Male
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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 giving false or fraudulent information is a criminal offence and 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. FULL NAME SIGNATURE DATE OF BIRTH
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h. however they can also apply directly. on the top right corner of your envelope.2013 intake Application Form Instructions Please use BLOCK LETTERS and BLACK INK > > > > > > > > > > > Applicants must complete all sections.2 & 3 candidates may f. attested copy of passport or National Identity Card.adspakistan. signature and remarks like. Ensure that each set of three (3) applications is presented neatly and professionally on A4 paper. Awards are offered to Pakistani Candidates whose proposed course of study will contribute to the long term development needs of the country. Serena Business Complex. Khayaban e Suharwardy. Applicants are encouraged to apply through their current organization. self-assessment form c.com. Course information is available directly from the institutions’ websites or the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) website (see details below).Australian Development Awards for Pakistan . A full list of the Australia Award conditions is contained in the Scholarship Handbook.pk ). under which you are applying. “'This is a true copy of the original'. G-5/1. THIS DOCUMENT IS NOT FOR SALE . A list of the priority sectors of study is available from the ADAPakistan office in Islamabad or from the website (http://www. The courses should be at different institutions. Please write the profile number. If your Australian Development Awards application is successful. DO NOT send this application to universities or other education institutions in Australia. feedback form b. attested1 copies of academic qualifications (all degrees and all transcripts) g.5 X 1. indicate your response with an “X” in the appropriate box. ADA website includes a full list of Australian education institutions that accept AusAID scholars. date. Note that IELTS requirements for a course varies with different universities and may be greater than AusAID’s requirement given below. attested copies of Employment letters specifying years of service and job description (for all years of employment). application form e. you will be required to sign a Contract with the Commonwealth of Australia and be bound by conditions of the Australia Award. Photo 1. You should choose two preferences of Master level courses offered by Australian institutions. Send three (3) hardcopies of this application form along with all attached documentation by courier to the following address : Online applications will not be accepted. Islamabad. available for provide copy of their current IELTS score card if available) > 1 Attestation should include organisation’s stamp. For “Yes” or “No” questions. three passport sized photos of applicant d. attested copy of IELTS score sheet (mandatory for profile 4 Candidates.5 This application must be completed in English. vertically secured together in the following order: a. Profile 1. It is important to choose a course that is a priority sector. Australian Development Awards (ADA) Office Level 4.
be able to demonstrate the ability to meet the English Language Proficiency requirements for the Scholarship.> download on the ADS-Pakistan website.immi. be currently residing in Pakistan. character etc. be applying for a Masters level course. 2 & 3 do not need to provide a current IELTS score at the time of application. at the time of application candidates applying under Profile 4 must have a current IELTS score of 7 with no band less than 6.gov.5 with no band less than 6 is required for eligibility).). and must return to his/her home country to take up a position that utilises his/her study for a minimum period of two years. have outlined a case that is clear about their objectives and motivation to make a contribution to development in Pakistan. Useful Australian Websites For information about Visas – Department of Immigration and Citizenship: http://www. General Eligibility Criteria Applicants must meet all of the Australia Awards general eligibility criteria. satisfy Australian Government requirements for international student visas for entry to Australia (heath. be able to meet the profile specific eligibility criteria under which they are applying (see the four profiles on the ADA-P website given below). These include: be Pakistani citizens (dual nationals are not eligible). not have held a foreign scholarship in the 24 months preceding the application (24 months are calculated from the date of arrival back in Pakistan to the closing date for applications). have completed 16 years of education.au THIS DOCUMENT IS NOT FOR SALE . candidates successful in preliminary screening with no current IELTS score. Please note that ADA reserves the right to change these conditions at any time without prior notice. however. not be married or engaged to a person who is eligible to hold Australian or New Zealand citizenship or permanent residence. be applying for courses that fall within the priority sectors identified on the ADA-P website given below.. not have applied for or hold permanent residency in Australia or New Zealand. be not more than 45 years of age at the time of application. have at least 2 years work experience in the field in which they are applying (5 years experience is required for applicants falling under profile 2). candidates applying under Profile 1. be applying to commence a new course of study and not be seeking support for a course already commenced in Australia (on-going study programs will not be supported). have a relevant academic background to proposed study in Australia. be able to provide a Police Security Clearance certificate at the time of Visa application. satisfy the admission requirements of the Australian tertiary institution and the course to be undertaken. not hold another scholarship. Submitting this application does not guarantee that you will receive a scholarship. be able to take up the scholarship in the year for which it is offered. will be required to take an IELTS test on short notice (an IELTS score of 6.
au To search for information about Australian Educational Institutions and courses .gov.cfm Australian Development Awards for Pakistan .gov.gov..au For information on Australian Development Awards in Pakistan – http://www.2013 intake 1.* / / Ma Female Do you have Dual Yes Nationality? Issue Date: Expiry Date: Yes No / / / / No *If you are waiting for a Passport to be issued.Personal Details Title Family Name NIC) Mr Other (as shown on Passport / (as shown on Passport / Mrs Please specify Ms Dr Given Names NIC) Date of Birth Gender Country of Citizenship Passport No. Are you living with a disability or working with people who are living with a disability? website www.CRICOS: http://cricos.studyinaustralia.com.adspakistan.australiaawards.com.For information about other Australian Government Scholarships (Australia Awards): http://www.pk For information on the Scholarships Handbook – http://www. First Preference Course Name Satisfies Country Specific Selection Criteria Yes No Course CRICOS Code Institution/University Course Type Second Preference Course Name Coursework Research Course CRICOS Code THIS DOCUMENT IS NOT FOR SALE .au For advice on studying in Australia: http://www. as soon as possible.au/scholar/studyin. Copy of your Passport should be made available to the ADA office in the country you are submitting this application to.dest.ausaid.pk) Under which profile are you applying? (descriptions of profiles are provided at our Profile 1 Profile 2 Profile 3 Profile 4 For Office Use Only before dispatching to Institution) (To be complete d by ADA Office ADA No.adspakistan.gov. OASIS ID.
in which country are you residing Have you studied overseas in the past? If ‘Yes’.Eligibility for an Australian Scholarship What is your country of citizenship? Are you currently residing in your country of citizenship? If not. provide Name of Scholarship: details Granted by which Australian Agency : Start date: End date: Course Completed: Country where study Completed: Do you currently hold or previously held any other scholarship from your own or another government or Yes No THIS DOCUMENT IS NOT FOR SALE .Institution/University Course Type IELTS Scores Coursework Overall Speaking Research Listening Reading Writing 2. have you been granted Visa no. No temporary residence status in Australia? Have you held any Australian Yes No Government scholarships in the past? If ‘Yes’. provide details Yes Years nths Country Name (for how long) Years Months Yes No Course title: Degree obtained: Duration: Year completed: Country: (for how long) Mo Have you applied for permanent Yes No residence in Australia or New Zealand? Are you entitled to Australian or New Yes No Zealand permanent residence or Excluding holidays or other short Yes visits.
Please provide an address where you can be contacted when a decision is reached.If ‘Yes’. Mobile no. Email be contacted in case of emergency) Postal code (if any) Country Work phone no.Contact Details Once submitted. (if any) THIS DOCUMENT IS NOT FOR SALE . Mobile no. this scholarship application takes several months to be finalised. provide details Name of Scholarship: Granted by: Start date: End date: Course Completed: Country where study Completed: 3. Fax no. Postal code (if any) Country Work phone no. Current residential address Address line 1 Address line 2 Town/City State/Province Home phone no. Email 1 Email 2 (if any) address. Fax no. (if any) Mailing address Provide details only if different from your current residential Address line 1 Address line 2 Address line 3 Town/City State/Province Postal code (if any) (person to Country Emergency Contact Details Name Relationship to applicant Address line 1 Address line 2 Town/City State/Province Home phone no.
4. Male Female Date of birth Provide family name and other names as shown in your spouse’s passport or other official identification / / (dd/mm/yyyy) Issue Date: Expiry Date: / / / / Will your spouse accompany you to Australia? 5. See ADA Handbook for Reunion airfare policy) separate list if there is not enough space) Yes Family name Given names Gender Country of citizenshipno. Passport Provide if child has a Will this child accompany you to Australia? No Male Female Date of birth / / Issue Date: Expiry Date: / / / / Child 2 passport. Yes Family name Given names Gender Country of citizenshipno. provide their details even if they will not accompany you to Australia. Passport Provide if child has a Will this child accompany you to Australia? No Male Female Date of birth / / Issue Date: Expiry Date: / / / / Child 3 Yes Family name Given names Gender Country of citizenshipno. Passport Provide if child has a passport. Family name Given names Gender Country of citizenship Passport no. Provide if spouse has a passport.Children Details Child 1 Yes (attach a No (Reunion airfare is included or excluded from the scholarships offer based on this clause.Spouse details If you have dependants (spouse and/or children under 18 years of age). Will this child accompany you to Australia? No Male Female Date of birth / / Issue Date: Expiry Date: / / / / THIS DOCUMENT IS NOT FOR SALE . Please note that the scholarship does not provide financial support for accompanying dependants.
7. may provide details. please answer the following: Have you taken an IELTS test? IELTS Scores (For profile 4 Candidates. For Profile 1.2 & 3 who have no current IELTS score. if available*) Yes No Yes / No Date test / taken Overall Score Listening Reading Writing Speaking Give details of any English language training undertaken / currently being undertaken.2 & 3 candidates. ADA will arrange IELTS test for those successful applicants under profile 1.English Language Proficiency Is English your first language? If ‘No’.Qualifications THIS DOCUMENT IS NOT FOR SALE . *Note: After the preliminary screening. IELTS score of 7 with no band less than 6 is a mandatory requirement for ADA application.6.
Past and Current Studies List by level of study. 1. Qualification title Level of study Secondary School Certificate Higher Secondary School Certificate Vocational. starting with highest level -Please include any studies you are currently undertaking and studies you have completed. technical diploma/Certificate Postgraduate Diploma 2. -Any documents not in English must be translated and certified copies of English Language translations must be attached. Qualification Title Level of study Name of institution Country Language of instruction Status Start date / / Completion date / / Secondary School Certificate Higher Secondary School Certificate Vocational. transcripts (DMCs) and certificates must be included with each application form. Qualification Title Level of study Name of institution Country Language of instruction Status Start date / / Completion date / / Secondary School Certificate Higher Secondary School Certificate Vocational. -Certified copies of Degrees. technical diploma/Certificate Postgraduate Diploma (complete/incomplete) Start date / / Completion date / / 4. technical diploma/Certificate Postgraduate Diploma Undergraduate Name of institution THIS DOCUMENT IS NOT FOR SALE . technical diploma/Certificate Postgraduate Diploma (complete/incomplete) 3. Qualification Title Level of study Name of institution Country Language of instruction Status (complete/incomplete) Secondary School Certificate Higher Secondary School Certificate Vocational.
Start date / / Completion date / / 8. go to Section 10. please attach two referee statements and a research proposal 9.g 061598D ) (CRICOS code is a 7digit number Coursework Research If you have chosen research.adspakistan. You should choose two courses of study offered by ADA Institutions. If your application for the first preference of Provide details of your proposed course of study.g 061598D ) (CRICOS code is a 7digit number e. in order of preference. or at different Institutions. THIS DOCUMENT IS NOT FOR SALE . It is important to choose a course that falls under a priority sector as declared by ADA. please attach two referee statements and a research proposal Coursework Research If you have chosen research.Proposed Study Program ADA are offered to Pakistani Candidates whose proposed course of study will contribute to the long term development needs of the country.com.Research Applicants If you do not intend to undertake 50 per cent or more of your course by research.pk or in the advertisement published in Newspapers of 6th February 2011 ADA website includes a full list of Australian Institutions that accept ADA students. Preference 1 Course Name Course CRICOS Code Institution/University Course Type Preference 2 Course Name Course CRICOS Code Institution/University Course Type e. A list of priority sectors is available from the ADA website www. attach a copy of the results for all completed subjects to each application form. To find out about the content of specific courses. You need to decide which Institution you would like to attend and choose an appropriate course. you should refer to the individual Institution websites. The courses may be either at the same Institution.Country Language of instruction Status(complete/inco mplete) If you have included incomplete studies.
Applicant’s Supporting Statement THIS DOCUMENT IS NOT FOR SALE . The outline should address the following: > > > > Proposed Title Objectives Relationship of this research to previous work in this field by yourself or others Significance and possible application of your proposed research to your country > Where possible.Special Requirements Are there any special requirements which you may need to complete your study program in Australia Yes (eg wheelchair access)? If ‘Yes’. please give details: (Note: the details will not adversely affect your application) No 2. please give details (only one fieldwork trip within Australia or to your country of citizenship is funded under ADA) 1.All Master level applicants whose study program will include at least 50 per cent research MUST attach an outline of the proposed research project (up to 1000 words) to each application form. proposed research method and plan including estimated schedule for completion and each step in research and thesis writing. If you have already applied to an eligible ADA Institution or had Do you intend to undertake fieldwork as part of your Yes No research program? If ‘Yes’. You MUST also attach 2 references in support of your application for a research ADA.
Attach a page if there is not enough room. Is there anything else you would like to add in support of your application for this scholarship? THIS DOCUMENT IS NOT FOR SALE . The answers must be in the applicants own words. How will the proposed training be of benefit to your country of citizenship? c. paraphrase. It is unethical to plagiarise. Why do you want to study in Australia? b. All such applications will be immediately ruled out. list specific actions.) d. a. copy or quote without citing the source.Please limit your answers to 100 words per question. What skills and knowledge do you hope to gain from your training in Australia? How do you propose to use them on return to your country of citizenship? (If possible.
Employment History Current employment (in Provide details if currently employed reverse chronological order) Position title Starting date / / Employing organisation Brief description of your duties and responsibilities (maximum 200 words) Will you be returning to this position after your scholarship studies? If ‘No’. what type of employment do you hope to gain after your studies? (maximum 100 words) Previous position 1 Yes No Provide details if previously employed Position title Starting date / / Finishing date / / Employing organisation Brief description of your duties and responsibilities (maximum 100 words) Previous position 2 Provide details if previously employed Position title Starting date / / Finishing date / / Employing organisation Brief description of your duties and responsibilities (maximum 100 words) THIS DOCUMENT IS NOT FOR SALE .3.
13 a. I agree that the level and field of study. for I nominate an ADA. How will the applicant’s selection assist your country’s development goals? On behalf of the Government of I declare that I have examined the documents attached to this form and am satisfied that they are authentic and relate to the applicant. Employer and Nominating Authority Statement Are you applying Under profile 1 or 2 ? Yes No (Please provide following details) (Go to 13 b) Support of the nominating/coordinating authority To be completed by all public sector applicants only in English by an authorised officer from the nominating/coordinating authority. and length of scholarship and fieldwork proposed in this application are appropriate and in accordance with the Government’s human resource development needs and training policy. Name of Title nominating Organisati authority on Contact details Signature Official Stamp THIS DOCUMENT IS NOT FOR SALE .
Employer and Nominating Authority Statement Are you applying through your organization? Yes No (Please provide following details ) (Please go to 14) Support of the applicant’s employer/supervisor To be completed in English by an authorised officer from your organisation/employer. Nominated by (name of organisation/employer): Please indicate the specific skills and capacities (not the qualification) you would expect the applicant to gain from the proposed study program: Name Contact details Signature Date Position Official Stamp / / THIS DOCUMENT IS NOT FOR SALE .Date / / 13 b.
A. Statement from last attended university or school that English is the language of instruction Curriculum Vitae or details about relevant employment One copy of the self-assessment form for eligibility to be attached on top of the three application forms Recent passport size photographs affixed to the three copies of the application form Employment letters specifying years of service and job description (for all jobs/ years of employment) B.14. Academic Documents: Yes Yes Yes Yes Yes Yes Yes No No No No No No No Certified copies of official transcript for Matriculation or O’ Levels (Secondary School Certificate) Certified copies of official transcript for Intermediate or A’ Levels (Higher Secondary School Certificate) Certified copies of official transcript and degree for Bachelors level study (Undergraduate) Certified copies of official transcript and degree for Masters level study (Postgraduate) (If applicable) Certified copies of official transcript and certificate / diploma for technical / vocational study (If applicable) Official English translations of all academic transcripts and degrees (if applicable) C. Research Applicants Only: Yes Yes Yes Yes Yes Yes No No No No No No Outline of proposed research project (for details see Section 9) References from two academic referees (if not available. Other Yes Yes Yes NA NA NA Any other relevant documentation in support of your ADA application Please list: THIS DOCUMENT IS NOT FOR SALE Yes NA . Required documentation: please tick if you have attached the following documents in support of your application. Documentary Evidence Please note: > Applications with incomplete supporting documentation will be rejected. > Three HARDCOPIES of the application form are required. applicants must provide certified* copies of English translations. All Applicants: Copy of passport personal information pages and/or ID Card IELTS English language test results. > EACH copy of the application form should have certified* copies attached of the relevant documents listed below (where applicable). please explain why) List of relevant publications and unpublished thesis D. > Where original documents are not in English.
Suharwardy. Personal Computer Skills Please answer the following questions to the best of your ability. Operating systems (eg Windows 2000)? e. first class gazette Public Servant or other formally recognized authority. Notary Public.com. If you are unsure about who is the appropriate person to certify your documents. Statistical packages for research Yes No students (eg Details: SPSS)? 6. Tel:+92 51 2600186-9 Fax: :+92 51 2600191 email :info@adspakistan. signed by an Oaths Commissioner. Do you use a PC regularly at work? 4. Have you undertaken any formal PC training? 3. Are there any comments you wish to make about your use of Personal Computers? THIS DOCUMENT IS NOT FOR SALE . This will assist ADA institutions to determine if you might require additional tuition at the commencement of you studies. 1. Email software (eg Outlook)? g. Word processing software (eg Word)? b. Spreadsheet software (eg Excel)? c. Database software (eg Access)? d. you should contact the Scholarships Manager at ADA Pakistan Office. Internet Explorer)? Yes Details: Yes Details: Yes Details: Yes Details: Yes Details: Yes Details: Yes Details: No No No No No No No h. Have you used a personal computer (PC)? 2. Level 4. Presentation software (eg PowerPoint)? f. Islamabad. Internet browsers (eg. How regularly do you use a PC? Daily Weekly Yes Details: Yes Details: Yes Details: No No No Monthly Yearly 5. Are you an experienced user of: a. 15.* Certified: a statement that the document is a true copy. Khayaban-e.pk. Serena Business Complex.
Agreement. 1. THIS DOCUMENT IS NOT FOR SALE .Applicant’s Authorisation. Declaration And Signature ADA is authorised to collect all items of information in this form under the Australia Awards which includes Australian Leadership Awards Scholarships/Fellowships and Australian Development Scholarships. and is bound by the requirements of the Privacy Act 1988 of the Commonwealth of Australia.
media releases and information circulated to ADA’s offshore counsellors and Australian education institutions. and/or its appointed managing contractor. concerning the Australia Awards. Ministers and members of Parliament. I authorise any Australian educational institution that makes me an offer of placement to provide to ADA details of that offer if requested to do so by the ADA. > Act in a manner befitting a recipient of an Australian Scholarship. to obtain copies of any of my relevant academic records/reports from the educational institution(s) that I have attended for purposes relating to my application for an Australian scholarship including: > > > For use in the selection process. > ADA has the right to vary or reverse any decision regarding an Australian scholarship made on the basis of incorrect or incomplete information. I agree that I will: > Immediately provide ADA with details of any incident that may reflect badly on the prestige of Australian Development Scholarship. and > Acknowledge the assistance given by the Australian Government in any written reports. I acknowledge that giving false or misleading information is a serious offence under the Criminal Code Act 1995 of the Commonwealth of Australia. Declaration and acknowledgement I declare in submitting this application form that the information contained in it and provided in connection with this application is true and correct. Understanding I understand and confirm that: > I have read and complied with the instructions to applicants and the contents of my application are true and correct. given names. Agreement If successful in gaining an Australian scholarship. Should I receive an Australian Development Scholarship. I authorise ADA to advise other Australian Government departments participating in the Australia Awards programme of my scholarship application. Name (title. To brief relevant Australian officials. publications or publicity associated with the award. but is not limited to. Promotional material may include.Authorisation I authorise AusAID. > Use the funds for the purposes granted. > Authorise a third party to conduct my Police Security Clearance on behalf of AusAID. leadership skills and my proposed study programme in Australia) in promotional material in hardcopy and on the Internet. I consent to the Australian Government using and disclosing extracts of my application (relating to my academic background and achievements. family name) Signature Date / / THIS DOCUMENT IS NOT FOR SALE . and > Decisions of the selection panel are final and confidential and no correspondence regarding outcomes of the selection process will be entered into. hereafter “the ADA”. To monitor my academic performance at my host education institution if I am awarded the scholarship.
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