Australian Development Scholarships (ADS)

2011 Application form

Instructions
Please use BLOCK LETTERS and BLACK INK

> Applicants must complete all boxes.

> This application must be completed in English.
> For “Yes” or “No” questions, indicate your response with an “X” in the appropriate box.
> Three copies of this application form and of all attached documentation must be submitted to the AusAID Office in your country.
> DO NOT send this application to Universities or TAFEs in Australia.
> ADS are offered to students whose course of study will contribute to the long term development needs of their country of
citizenship. It is important to choose a course that is a priority field of study for your country. A list of the priority fields of study is
available from the AusAID office in your country of citizenship or the country profile on the AusAID Website
(http://www.ausaid.gov.au/scholar).
> AusAID’s website includes a full list of Australian Institutions that accept ADS students. 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).
> You may choose two courses of study offered by ADS Institutions. The courses may be either at the same Institution, or at different
Institutions.
> If your ADS application is successful, you will be required to sign a Contract with the Commonwealth of Australia and be bound by
conditions of the ADS scholarship. A full list of the ADS conditions is contained in the ADS Handbook, available for download on the
AusAID website. 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.

Useful Australian Websites

For information about Visas – Department of Immigration and Citizenship: http://www.immi.gov.au

For information about other Australian Government Scholarship programs: http://www.australianscholarships.gov.au

For advice on studying in Australia: http://www.studyinaustralia.gov.au

To search for information about Australian Educational Institutions and courses - CRICOS: http://cricos.dest.gov.au

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 1. Personal details

Mr Mrs Ms Miss Dr
Title
Other Please specify

Family Name (as shown on Birth Certificate)

Married Name (if different from name on Birth Certificate)

Given Names (as shown on Birth Certificate)

Country of citizenship

Gender Male Female

Date of Birth / /
*If you are waiting for a Passport to be issued, your Passport Number should be made
Passport no.* available to the AusAID office in the country you are submitting this application to, as soon as
possible.

Under which category are you applying?

Public Sector Open/Equity Targeted

For Office Use Only (To be complete by Post before dispatch to Institution)

AusAID ID No. Satisfies Country Criteria Yes No

First Institution
First Preference Course
First Preference Course Code
Requested Level of Study
Second Institution
Second Preference Course
Second Preference Course Code
Requested Level of Study
English Language Scores IELTS TOEFL

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2. Eligibility for an Australian Scholarship

What is your country of Citizenship?

Years
Are you currently residing in your country of Citizenship? Yes No
Months
Years
If not, in which country are you residing
Months
Have you applied for permanent residence in Australia or
Yes No
New Zealand?
Are you entitled to Australian or New Zealand permanent
Yes No
residence or citizenship status?
Excluding holidays or other short visits, have you been
granted temporary residence status in Australia?
Yes No Visa no.
If ‘Yes’ provide a visa no. and attach a copy of your visa to each
application.
Have you held any Australian Government scholarships
Yes No
in the past?
If ‘Yes’, provide details

Do you currently hold any other scholarship from your

Yes No
own or another government or sponsor?
If ‘Yes’, provide details

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3. Contact Details

This scholarship application takes several months to be finalised once submitted. Please give an address where you can be contacted when a decision is
reached.

Current residential address

Address line 1

Address line 2

Address line 3

Town/City Postal code (if any)

State/Province

Country

Home phone no. Work phone no.

Mobile no. Fax no. (if any)

Email 1

Email 2 (if any)

Mailing address Provide details only if different from your current residential address.

Address line 1

Address line 2

Address line 3

Town/City Postal code (if any)

State/Province

Country

Emergency Contact Details

Name

Relationship to applicant

Address line 1

Address line 2

Address line 3

Town/City Postal code (if any)

State/Province

Country

Home phone no. Work phone no.

Mobile no. Fax no. (if any)

Email

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 4. Spouse details
If you have dependants (spouse and/or children under 18 years of age), provide their details even if they will not accompany
you to Australia. Please note that the scholarship does not provide financial support for accompanying dependants.
Family name Provide family name and other names as shown in
your spouse’s passport or other official identification
Given names document

Gender Male Female Date of birth / /

Country of citizenship
Passport no. Provide if spouse has a passport.

Will your family be accompanying you to Australia during your scholarship? Yes No

5. Children Details (attach a separate list if there is not enough space)

Child 1

Family name

Given names

Gender Male Female Date of birth / /

Country of citizenship

Passport no. Provide if child has a passport.

Child 2

Family name

Given names

Gender Male Female Date of birth / /

Country of citizenship

Passport no. Provide if child has a passport.

Child 3

Family name

Given names

Gender Male Female Date of birth / /

Country of citizenship

Passport no. Provide if child has a passport.

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6. Qualifications

Past and Current Studies List by level of study, starting with highest

Please include any studies you are currently undertaking and studies you have completed. One certified copy of any official transcripts,
certificates and certified copies of English Language translations must be included with each application form.
Any documents not in English must be translated.

Qualification name 1

Secondary (High School) Vocational, technical

Level of Study
Undergraduate Postgraduate

Name of institution

Country

Language of instruction

Status (complete/incomplete) Start Date / / Graduation date / /

Qualification name 2

Secondary (High School) Vocational, technical

Level of Study
Undergraduate Postgraduate

Name of institution

Country

Language of instruction

Status (complete/incomplete) Start Date / / Graduation date / /

Qualification name 3

Secondary (High School) Vocational, technical

Level of Study
Undergraduate Postgraduate

Name of institution

Country

Language of instruction

Status (complete/incomplete) Start Date / / Graduation date / /

If you have included incomplete studies, attach a copy of the results for all completed subjects to each application form.

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 7. Proposed Study Program

ADS will only be offered to students whose course of study will contribute to the long term development needs of their country of citizenship. It is
important to choose a course that is a priority field of study for your country. A list of priority fields is available from the AusAID office in your country
or in the relevant country profile on the AusAID website (http://www.ausaid.gov.au/scholar).

AusAID’s website includes a full list of Australian Institutions that accept ADS students. You need to decide which Institution you would like to
attend and choose an appropriate course. To find out about the content of specific courses, you should refer to the individual Institution websites.

You may choose two courses of study offered by ADS Institutions. The courses may be either at the same Institution, or at different Institution. If
your application for the first choice of study is unsuccessful, AusAID will forward your application to your second choice.

Provide details of your proposed course of study, in order of preference.

Preference 1
Course Name
Institution Name
Course CRICOS number
Preference 2
Course Name
Institution Name
Course CRICOS number

8. English Language Proficiency

Is English your first language? Yes No

If ‘Yes’, go to Section 9.
If ‘No’, please answer the following:
Was English the language of your secondary/high school or tertiary studies? Yes No

If ‘Yes’, provide a statement from the institution verifying the language of instruction, and go to Section 9.
If ‘No’, please answer the following:
Have you taken an IELTS or TOEFL test? Yes No
Test Date test taken / / Score
If ‘No’, when do you expect to complete the test? / /

Give details of any English

language training currently being
undertaken.

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 9. Research Applicants

If you do not intend to undertake 50 per cent or more of your course by research, go to Section 10.

All PhD and Master 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. 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, proposed research method and plan including estimated schedule for completion and each
step in research and thesis writing.
Institutions may require a more detailed submission from PhD candidates. You will be asked for this later if required. It is in
your best interests to prepare a more detailed submission to provide to Institutions if requested.

You MUST also attach 2 references in support of your application for a research ADS.

If you have already applied to an eligible ADS Institution or had correspondence with an Institution staff member, please
attached details and supporting documentation to each application form.

Do you intend to undertake fieldwork as part of your research program? Yes No

If ‘Yes’, please give details (only one fieldwork trip within Australia or to your country of citizenship is funded under ADS)

10. Special Requirements

Are there any special requirements which you may need to complete your
Yes No
study program in Australia (eg wheelchair access)?
If ‘Yes’, please give details:

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 11. Applicant’s Supporting Statement
Please limit your answers to 100 words per question. Attach a page if there is not enough room.

a. Why do you want to study in Australia?

b. How will the proposed training be of benefit to your country of citizenship?

c. 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, list specific actions.)

d. Is there anything else you would like to add in support of your application for this scholarship?

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12. Employment history

Current employment Provide details if currently employed

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? Yes No

If ‘No’, what type of

employment do you hope
to gain after your
studies? (maximum 100
words)

Previous position 1 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)

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 13a. Employer and Nominating Authority Statement

PART B: For ALL applicants (if employed) - Support of the applicant’s department/private sector employer
To be completed in English by an authorised officer from your organisation/employer.

Nominated by (name of organisation/employer):

Please indicate the specific skills (not the qualification) you would expect the applicant to gain from the proposed training
program:

Name Position

Contact details

Signature Official Stamp

Date / /

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 13b. Employer and Nominating Authority Statement

PART B: For Public Sector applicants only - Support of the nominating/co-ordinating authority
To be completed for all public sector applicants only in English by an authorised officer from the nominating/co-ordinating authority.

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. I agree that the level and
field of study, 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.

I nominate for an ADS.

Name of Title
nominating
authority Organisation

Contact details

Signature Official Stamp

Date / /

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 14. Documentary Evidence
Please note:

> Applications with incomplete supporting documentation will be rejected.

> THREE COPIES of the application form are required.
> EACH copy of the application form should have certified* copies attached of the relevant documents listed
below.
> Where original documents are not in English, applicants must provide certified* copies of official English
translations.

Required documentation: please tick if you have attached the following documents in support of your application.

A. All Applicants:

Birth certificate or your passport personal information pages Yes N/A

IELTS or TOEFL English language test results Yes N/A

Statement from university or school that English is the language of instruction Yes N/A

Curriculum Vitae or details about relevant employment Yes N/A

B. Vocational, Technical and Undergraduate course applicants:

Official secondary school results Yes N/A

Official English translations of school results Yes N/A

C. Postgraduate course applicants:

Official post-secondary and tertiary certificates/degrees Yes N/A

Official translations of post-secondary and tertiary certificates/degrees Yes N/A

Official post-secondary and tertiary transcripts of results Yes N/A

Official translations of post-secondary and tertiary transcripts of results Yes N/A

D. Research applicants only:

Outline of proposed research project (for details see Section 9) Yes N/A

Reports from two academic referees (if not available, please explain why) Yes N/A

List of relevant publications and unpublished theses Yes N/A

E. Other

Any other relevant documentation in support of your ADS application Yes N/A
Please list:

* Certified: a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notary or other formally recognised authority. If
you are unsure about who is the appropriate person to certify your documents, you should contact an AusAID officer at the Australian Diplomatic
Mission for your country of citizenship.

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 15. Personal Computer Skills
Please answer the following questions to the best of your ability. This will assist ADS institutions to determine if you might require additional tuition
at the commencement of you studies.
1. Have you used a personal computer (PC)? Yes No

Details:
2. Have you undertaken any formal PC training? Yes No

Details:
3. Do you use a PC regularly at work? Yes No

Details:

4. Are you an experienced user of:

a. Word processing software (eg Word)? Yes No

Details:
b. Spreadsheet software (eg Excel)? Yes No

Details:
c. Database software (eg Access)? Yes No

Details:
d. Operating systems (eg Windows 2000)? Yes No

Details:
e. Presentation software (eg PowerPoint)? Yes No

Details:
f. Email software (eg Outlook)? Yes No

Details:
g. Internet browsers (eg. Internet Explorer)? Yes No

Details:
h. Statistical packages for research students (eg Yes No
SPSS)?
Details:

5. How regularly do you use a PC?

Daily Weekly Monthly Yearly

6. Are there any comments you wish to make about your use of Personal Computers?

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16. Applicant’s authorisation, agreement, declaration and signature
AusAID is authorised to collect all items of information in this form under the Australian Government’s scholarships
programme entitled Australian Scholarships, 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.

Authorisation
I authorise AusAID, or its appointed managing contractor, to obtain copies of any of my relevant academic records/reports
from the education institution(s) that I have attended for purposes relating to my application for an Australian scholarship
including:
> For use in the selection process for an Australian scholarship;
> To monitor my academic performance at my host education institution if I am awarded an Australian scholarship; and
> To brief relevant Australian officials, Ministers and members of Parliament.
Should I receive an Australian Development Scholarship, I consent to the Australian Government using and disclosing extracts
of my application (relating to my academic background and achievements, leadership skills and my proposed study
programme in Australia) in promotional material in hardcopy and on the Internet. Promotional material may include, but is not
limited to, media releases and information circulated to AusAID’s offshore counsellors and Australian education institutions,
concerning the Australian Scholarships programme.
I authorise any Australian education institution that makes me an offer to enrol at that institution to provide to AusAID details of
that offer if requested to do so by AusAID.
I authorise AusAID to advise other Australian Government departments participating in the Australian Scholarships programme
of my scholarship application.

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;
> AusAID has the right to vary or reverse any decision regarding an Australian scholarship made on the basis of
incorrect or incomplete information; and
> Decisions of the selection panel are final and confidential and no correspondence regarding outcomes of the selection
process will be entered into.

Agreement
If successful in gaining an Australian scholarship, I agree that I will:
> Immediately provide AusAID with details of any incident that may reflect badly on the prestige of an Australian
Scholarship;
> Act in a manner befitting a recipient of an Australian Scholarship;
> Use the funds for the purposes granted; and
> Acknowledge the assistance given by the Australian Government in any written reports, publications or publicity
associated with the award.

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.
I acknowledge that giving false or misleading information is a serious offence under the Criminal Code Act 1995 of
the Commonwealth of Australia.

Name (title, given names, family name) Signature Date

/ /

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