7/18/2019 Ads Applicationform 2014 http://slidepdf.com/reader/full/ads-applicationform-2014-5691de8fe4a37 1/30 Australia Awards Scholarships 2014 Intake Application Form Instructions Please print neatly using block letters (huruf cetak) and black ink > Before completing this form, you must read the Australia Awards Scholarships Policy Handbook (www.ausaid.gov.auaustralia!awards"ocumentsscholar!handbook.pdf # and the $ndonesia country profile (http%www.ausaid.gov.auaustralia!awards"ocumentsindonesia.pdf#. Applicants also are encouraged to review all information available on the Australia Awards Scholarships & $ndonesia website (www.australiaawardsindo.or.id # > 'ou must complete all fields marked with an and all relevant sections. > )his application must be completed in *nglish. > +or 'es- or o- /uestions, indicate your response with an 0- in the appropriate bo1. > 2ne (3# copy of this form and of all attached documents must be received by 19 July 2013 at the Australia Awards 2ffice at 4edung 5irausaha, 6 th +loor. 7l. H.8. 8asuna Said 9av.:!; 9uningan, 7akarta 3<=>?. > "o not send this application to universities or other institutions in Australia. > Australia Awards Scholarships will be offered only to those whose course of study will contribute to the long!term development needs of $ndonesia. A list of the priorities is available under :hoosing a :ourse of Study- on page @ of this application form. > AusA$"s website includes a list of Australian niversities that may receive Australia Awards Scholarship recipients. :ourse of study information is available directly from the niversities websites or the :ommonwealth 8egister of $nstitutions and :ourses for 2verseas Students (:8$:2S# website (see page C & seful 5ebsites#. > 'ou may provide two preferences for courses of study. 'ou should consider two Australian universities rather than two courses at the same university, Dust in case you do not meet the admission re/uirements of the first Australian university. > $f your application is successful, you will be re/uired to sign a :ontract with the :ommonwealth of Australia and be bound by conditions of the scholarship. A full list of the conditions is contained in this application form (page <; ! <C# and in the Handbook. Please note that AusA$" reserves the right to change these conditions at any time. > Submitting this application does not guarantee that you will receive a scholarship. > $f you do not receive an invitation to an interview from the Australia Awards office by mid!"ecember, you should assume that your application has been unsuccessful. > Applicants must not fill in section <; of the application form. )his section is for use by the Einistry of State Secretariat of the 8epublic of $ndonesia (9*ES*)*4# and refers only to selected candidates. > $n 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 19 July 2013 Applications should be submitted as early as possible 1
General Information Notes Australia Awards Scholarships are an important component of Australias investment in education. $n $ndonesia, Australia Awards Scholarships provide opportunities to study in Australia at P2S)48A"A)* level. )hey are providedto $ndonesian citiFens to provide enhanced leadership, knowledge and technical skills to the 4overnment of $ndonesia,to tertiary institutions and to strategic organisations that are driving sustainable development.
Australia Awards Scholarships have been an important component of the Australian 4overnments efforts
to reduce poverty and achieve sustainable development since the 3=;?s. )his is achieved through%
• developing capacity and leadership skills so that individuals can contribute to development in $ndonesiaG
• building people!to!people linkages at individual, institutional and national levels between $ndonesia and Australia.
)here are a number of supplementary programs associated with Australia Awards Scholarships in $ndonesiaincluding the Australia Awards eadership Program and the Allison SudradDat PriFe.
Public applicants are from government organisations, state universities and state owned enterprises and must beapproved by training or foreign cooperation bureaus (B9# of their local or central agencies (see page <@#. Publicapplicants from government agencies outside 7akarta may apply directly to the AS)8A$A A5A8"SS:H2A8SH$PS program office with the approval of their relevant Kakanwil or Kadinas and approval from Bupati or 4overnor (or representative# where necessary. Calon Pegawai Negeri Sipil (:PS# are not eligible to apply.
Open applicants are from private organisations, private universities and also include recent university graduates. o
government approval is re/uired and applications are to be submitted directly to the Australia Awards office. A letter of support from the applicants home agency, institution or private university may be included with the application. Publicservants ( p egawai n egeri # cannot apply as Iopen applicants.
Targeted and on!Targeted "ategory
AS)8A$A A5A8"S S:H2A8SH$PS are awarded as ITargeted’ or INon-Targeted’ . p to 6?J of AS)8A$A A5A8"S S:H2A8SH$PS are TargetedG available for nominated staff from 4overnment of $ndonesia 9ey Agencies,)argeted Sectors and from AusA$" 4eographic +ocus Areas3. +urther information on each of these sub!categories isavailable at www.australiaawardsindo.or.id
At least @?J of AS)8A$A A5A8"S S:H2A8SH$PS are on!Targeted available for public servants and non!public servants outside the AusA$" 4eographic +ocus Areas.
Scholarships are for full!time study for a Easters or "octorate degree from Australian tertiary institutions. )he
scholarship provides up to nine months full!time language and academic preparation in $ndonesia. Students mustachieve satisfactory results in this training to be able to continue their scholarships.
#ocial inclusion*ligible candidates with a disability or from organisations working with the disabled are encouraged to apply. 5omenand candidates within AusA$" 4eographic +ocus Areas are also encouraged to apply.
Eligiilit!$ %&&' "*$*T&# +,#T-
> be an $ndonesian citiFen and be residing in and applying for the scholarship from $ndonesia
> not be married or engaged to a person who is eligible to hold Australian or ew Kealand citiFenship or permanent
resident status, at any stage of the application, selection, mobilisation processes or while on!scholarship in Australia
> satisfy Australian 4overnment re/uirements for international student entry to Australia (health, character etc#
> not be applying for a visa to live in Australia
> not be applying for another long!term Australia Award unless they have resided outside Australia for twice the
length of the total time that they were in Australia (for e1ample, a previous Australia Awards Scholarship recipient
in Australia for four years will not be eligible to apply for another Australia Awards Scholarship until they have
resided outside Australia or back in $ndonesia for eight years#
> have satisfied any specific criteria established by $ndonesia or government of $ndonesia
> not be current serving military personnel
> be able to satisfy all re/uirements of the "epartment of $mmigration and :itiFenship ("$A:# for an AusA$" student
visa and
1 Aceh, usa )enggara )imur, usa )enggara Barat, Papua, 5est Papua
> be able to satisfy the admission re/uirements of the Australian university at which the Scholarship is to be
undertaken.
#P&"$.$"/ "*$*T&# +,#T-
> be applying for courses that fall within the areas of priority (see :hoosing a :ourse of Study- below#
> at the application closing date, be not older than >< years of age
> have a 4rade Point Average (4PA# of at least <.= on a scale of ma1imum >.? (<.6; for applicants from AusA$"
4eographic +ocus Areas# and an *nglish language proficiency of at least ;.? in $*)S (;?? in paper!based )2*+
or C3 in internet based )2*+ ! $B)#. )he $*)S or )2*+ result must be current (no earlier than <?3<#. o other
*nglish language test will be accepted (specifically the result from a TOEFL Prediction Test is not accepted#.
:ontact details of the *nglish language test centre must be provided for verification of test results.
> have a 4rade Point Average (4PA# of at least <.6; for recipients with a disability as declared on the AS)8A$A
A5A8"S S:H2A8SH$PS application form.
> apply for a degree at a level higher than their current highest /ualification%
o already hold an undergraduate degree, if applying for a Easters
o already have a Easters, if applying for a "octorate
> if applying for a "octorate, applicants will be restricted to staff of universities, higher education institutions,
research institutes, key policy makers and targeted candidates in other agencies associated with AusA$" activities
> it is highly desirable for "octorate applicants to have a letter of support from an Australian university for their
proposed field of study
> answer all relevant /uestions on the application form
> be willing and available to undertake full!time (Eonday ! +riday ?L??!3C??# *nglish for Academic Purposes (*AP#
training in $ndonesia prior to studying in Australia, if offered a scholarship.
"hoosing a "ourse of Stud!
:andidates are encouraged to apply to study courses which fall within AusA$"Ms priority areas (P"A#. )he P"A relatedirectly to the strategic obDectives contained in the Australia and $ndonesia :ountry Strategy. An indicative list of the
areas for study follows.
ustralia$ndonesiaPartnershipPriority reas(P*)
#ustainable %roth and&conoic +anageent
*eocracy Justice and%ood %oernance
$nesting in People #afety and Peace
*escription ofP*
Ipro!ing econoic polic"and anageent# reducingconstraints to growt$ inin%rastructure and
producti!it"# and ipro!ingnatural resource
anageent# en!ironental go!ernance and response tocliate c$ange&
Strengt$ening t$ecapacit"# accounta'ilit"and responsi!eness o%legal# deocratic ando!ersig$t institutions# and ipro!ing local
go!ernent and pu'lic%inancial anageent&
Better (ualit"# accessand go!ernance ineducation# and 'etter$ealt$ access ands"stes
Ipro!ing responses to$uanitarian needs#eergencies and!ulnera'ilit" todisasters# andipro!ing capacit" to
ensure transportsecurit" and to countert$reats %rotransnational crie&
B% I% "our stud" area is not listed $ere# "ou a" still appl" %or a %ield o% stud" related to t$e work o% )us)I* in Indonesia& For ore in%oration see t$e
)ustralia Indonesia Partners$ip Countr" Strateg" at+ $ttp+,,www&ausaid&go!&au,Pu'lications,Pages,)ustralia-Indonesia-Partners$ip-Countr"-Strateg"-
../-01-englis$&asp 2
:andidates considering study for particular professions should note that AS)8A$A A5A8"S S:H2A8SH$PS
does not include the practical training period re/uired for professional registration, e.g. medical internships, legal
articles etc. Successful recipients are e1pected to complete such training in their own country.
Selection #rocess
All applicants are considered by an independent 7oint Selection :ommittee comprised of Australian and $ndonesian
academics. 2nly those shortlisted will be interviewed. )he interview will assess candidatesM academic ability, clarity of
study goals, and cultural adaptability. A critical consideration will be how well the AS)8A$A A5A8"S
S:H2A8SH$PS applicant is able to e1plain the relevance of their proposed study area to the development of
$ndonesia. )he interview will be accompanied by an $*)S test of *nglish language proficiency.
+inal selection is obDective and based on the principles of merit and e/uity. )he final list of recipients is subDect to
scrutiny and endorsement by AusA$" and 4overnment of $ndonesia ! State Secretariat.
#&&"T$O 4,OT#-
> p to 6?J of awards will be offered to applicants from the )argeted :ategory including up to @?J of this number
from AusA$" 4eographic +ocus Areas
> At least @?J of awards will be offered to applicants from the on!)argeted :ategory,
> L;J of awards at Easters level and up to 3;J of awards at "octorate (Ph"# level. (B doctoral level study is only
open to staff of universities, higher education institutions, research institute, key policy makers and targeted
candidates in other organiFations associated with AusA$" activities#.
> an e/ual number of awards will be offered to men and women.
OT$.$"T$O O. T5& #&&"T$O '&#,T
All applicants will be advised whether or not they have been selected for an interview. All interviewed applicants will be
notified whether or not they have been awarded an AS)8A$A A5A8"S S:H2A8SH$PS. )he result is final and no
correspondence will be entered into. 5here appropriate, notification will include details of pre!departure training
(*nglish, academic skills, cultural preparation#. )his training is compulsory and full!time (see page C for step by step of
AS)8A$A A5A8"S S:H2A8SH$PS Application Process#.
$e%uirements for Scholarship $ecipients
Prior to traelling to ustralia scholarship recipients ust-
> meet the minimum *nglish language re/uirement of their chosen Australian university (usually $*)S of C.; with no
band less than C.?#
> at the completion of *AP training, candidates must achieve a minimum score of $*)S C.? for AS)8A$A
A5A8"S S:H2A8SH$PS 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 re/uirements for a student visa
> receive 4overnment of $ndonesia endorsement
> be medically fit to commence studies in Australia.
$n ustralia scholarship recipients ust-> abide by the conditions of the scholarship and the rules of Australian tertiary institutions
> abide by the rules and regulations governing a student visa
> act in a way that will not bring disrepute to AusA$", or to any Australian university or to $ndonesia
> return to $ndonesia for a period of two years at the completion of their studyresearch program in Australia. $f during
the two years e1clusion period the scholarship recipients return to Australia, a debt to the :ommonwealth may be
activated 28 any time spent in Australia may be added to the two year e1clusion period. :alculation of the two
years e1clusion period starts when the scholarships recipients arrive in $ndonesia, not the visa e1pire date.
&hat do Australia Awards Scholarships co'er(> Pre-Course Englis$ & provision of *nglish for Academic Purposes training prior to commencement of studies in
Australia (including an in!$ndonesia stipend#
> In-Indonesia Stipend for the period from the commencement of Pre!:ourse *nglish to the date of recipient
mobilisation. )his does not apply to any deferral period.
> 3edical e2aination and 2-ra" costs in order to comply with Student Oisa re/uirements
> )us)I* Student 4isa and Student *ependant 4isa
> Outward )ir%are (economy! one way# from the airport closest to the recipients home location to the international
airport closest to the Australian university selected for study by the recipient
> O!erseas Student 5ealt$ Co!er 6OS5C7 ! recipient only (recipients are re/uired to maintain 2SH: for any
accompanying family in order to satisfy visa re/uirements#.
> Esta'lis$ent )llowance payable into the recipients bank account after arrival in Australia
> Contri'ution to Li!ing E2penses (in Australia Stipend# ! payment of a fortnightly contribution to living e1penses
(:*#.
> Introductor" )cadeic Progra 6I)P7 for a period of >!C weeks undertaken prior to the commencement of Easters
or Ph" studies
> 3asters O8 P$* Tuition Fees & including all compulsory fees for the course in which the recipient is accepted into
> Suppleentar" )cadeic Support ! provided where it is deemed essential to assist recipients to pass course
subDects.
> Fieldwork ! holders of a scholarship where research comprises at least ;? percent of the program may receive a
return economy class airfare to $ndonesia to undertake essential fieldwork.
> 8eunion )ir%are ! is available to a Isingle recipient after the successful completion of the first year of studyG
subse/uent reunion airfare entitlements will be available on an annual basis for the duration of the AS)8A$A
A5A8"S S:H2A8SH$PS, e1cept for the final year of the AS)8A$A A5A8"S S:H2A8SH$PS.
> 5oeward )ir%are (economy! one way# from the international airport closest to the Australian university selected for
study by the recipient to the airport closest to the recipients home location..
Famil! Entr!8ecipients can bring their immediate families to Australia at their own cost, if their families meet AusA$" and
immigration re/uirements. +amilies are normally permitted to Doin eight (L# weeks after the recipientMs arrival.
Australia Awards Scholarships2014 Intake Application Form
1. Personal details
"ro&ide s#pporting doc#mentar% e&idence of %o#r f#ll name( date of $irth( gender and co#ntr% of
citi)enship. *or e+ample( the identification page of %o#r passport or other official identification
doc#ment iss#ed $% %o#r co#ntr% of citi)enship.
, Denotes mandator% field
Attach a recent
passport si)e photo.
- + cm.
Title, r rs s iss Dr
!ther0"lease specif%1
2i&en name, #harli 3adri 'nter %o#r famil% name and other names asshown in %o#r 4irth Certificate( "assport orother official identification doc#ment. If %o#ha&e onl% one name( enter it in $oth fields.*amil% names, 5anon
Date of $irth, 67/ 8/ 3==3 dd/mm/%%%% 2ender, ale *emale
"lace of $irth, 0State/pro&ince1 2orontalo
Which co#ntr% are %o# li&ing in now9, anado
a&e %o# applied( or are %o# intending to appl%( for permanent residenc% or
A#sAID will consider offering %o# a scholarship onl% if %o#r co#rse of st#d% will contri$#te to the longterm needs of %o#rco#ntr%. ote that the proposed program of st#d% sho#ld $e appropriate to %o#r academic #alification and wor@e+perience.
e<uested 8e#el o$ study,- 1ou will not be allowed toupgrade your course from thelevel at which you are first
placed0.
asters
Doctorate 0"hD1
7ype o$ study) -&asterscoursewor# program can contain aresearch pro!ect up to 234 of the&asters. 5andidate decide the topic
*ollowing A#stralian #ni&ersities are #nder contract to A#sAID to pro&ide co#rses for AUSTRALIA AWARDS
SC!LARSI"S recipients. Recipients are
re#ired to find a s#ita$le co#rse of st#d% at one of these A#stralian #ni&ersities. "hD candidates m#st find a s#per&isor at
one of these #ni&ersities. "lease &isit the following we$site for more details on A#stralian 'd#cational Instit#tions and
co#rses CRIC!S: http://cricos.deewr.go&.a#
• Australian &aritime 5ollege
• Australian 5atholic University
• 5arnegie &ellon University
• 5entral 7ueensland University
• 5harles Darwin University
• 5harles Sturt University
• 5urtin University of "echnology
• Dea#in University
• 8dith 5owan University
• 9riffith University
• :ames 5oo# University
• a "robe University
• &ac'uarie University
• &onash University
• &urdoch University
• 7ueensland University of "echnology
• (&I" University
• Southern 5ross University
• Swinburne University of "echnology
• "he Australian ;ational University
• "he <linders University of South Australia
• "he University of Adelaide
• "he University of &elbourne
• "he University of 7ueensland
• "he University of Sydney
• "he University of estern Australia
• U5 School of 8nergy and (esources
• University of 6allarat
• University of 5anberra
• University of ;ewcastle
• University of ;ew 8ngland
• University of ;ew South ales
• University of South Australia
• University of Southern 7ueensland
• University of "asmania
• University of "echnology, Sydney
• University of the Sunshine 5oast
• University of estern Sydney
• University of ollongong
• =ictoria University
• 6ond University
• "he University of ;otre Dame Australia
Proposed pre$erences
If %o# are selected for the scholarship the A#stralia Awards !ffice will forward %o#r application to %o#r prefer A#stralian#ni&ersit% and co#rse of st#d%. <o# need to decide which A#stralian #ni&ersit% %o# want to attend and choose anappropriate co#rse. <o# sho#ld choose two co#rses of st#d%. <o# are enco#raged to choose two different A#stralian#ni&ersities rather than two different co#rses at the same #ni&ersit%. If %o#r application for the first choice of st#d% is#ns#ccessf#l( A#sAID will forward %o#r application to %o#r second choice. The CRIC!S code from %o#r co#rse can $efo#nd on the Commonwealth Register of Instit#tions and Co#rses for !&erseas St#dents 0CRIC!S1 We$sitehttp://cricos.deewr.go&.a#
To find o#t a$o#t the content of specific co#rses( %o# sho#ld refer to the indi&id#al A#stralian #ni&ersit% we$sites. Thisinformation can also $e fo#nd on the AUSTRALIA AWARDS SC!LARSI"S Information CD which can $e o$tained fromthe A#stralia Awards !ffice or AUSTRALIA AWARDS SC!LARSI"S we$site http://www.a#straliaawardsindo.or.id.
Pre$erence 1)
Co#rse title or partic#lar foc#sarea within %o#r identifiedproposed *ield of St#d%.,
Complete this section if the st#dies will $e $% esearc% or a com$ination of esearc% and Courseor(. '.g. Doctorateor asters $% Research. !therwise proceed to ne+t #estion. Answers sho#ld $e concise $#t s#fficient to e+plain thenat#re of %o#r research proposal to the selection panel. Please note ord limits. +nyt%in" o#er t%is limit ill not beconsidered.
!nl% pro&ide pre&io#s emplo%ment that is rele#ant to %o#r application. 'mplo%ment histor% sho#ld also incl#de wor@e+perience( comm#nit% wor@ and &ol#ntar% wor@.
1. Pre#ious position
"osition title
!rganisation
Start date / / 'nd date / /
D#ties/responsi$ilities
-ma> @33 characters,
appro> F3%33 words limit0
2. Pre#ious position
"osition title
Start date / / 'nd date / /
!rganisation
D#ties/responsi$ilities
0ma+ >== characters(appro+ 6== words limit1
1. nter#ie Centre )
"lease tic@ %o#r preferred inter&iew center. 0"lease note <o#r choice is not g#aranteed.1
Limit %o#r answers to >== characters( appro+ =6== words( per #estion. Attach a page if not eno#gh room on this form .
Please note ord limits. +nyt%in" o#er t%is limit ill not be considered.
1. '%y do you ant to study in +ustralia,)
2. '%at s(ills and (noled"e do you %ope to "ain and %o do you propose to use t%em,)
3. o %a#e you contributed to sol#in" a c%allen"e and to implementin" c%an"e or re$orm, *Be speci$ic andinclude= %at aspects o$ your leaders%ip (noled"e@ s(ills and practice you consider to be ell establis%ed ande$$ecti#e %ic% people or or"anisations you or(ed it% to sol#e t%e problem and %at creati#e met%ods ereused.&,)
"lease note: <o# are responsi$le for pro&iding all s#pporting doc#ments are pro&ided. If %o# do not pro&ide all re#ired
doc#ments %o#r application will $e reGected.
/ CP- of the completed application form.
+t least one cop% of the application form sho#ld ha&e certi$ied) copies attached of the rele&ant doc#ments
listed $elow.
Where original doc#ments are not in 'nglish( %o# m#st pro&ide certi$ied) copies of official 'nglish translationsif %o# are selected for an inter&iew.
* Certified a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notary or otherformally recognised authority . If you are unsure about who is the appropriate person to certify your documents, youshould contact the AUS"(AIA AA(DS S5G+A(SGIPS +ffice.
e<uired documentation: please tic@ if %o# ha&e attached the following doc#ments in s#pport of %o#r application.
+ll applicants= */ssential&
<o# UST incl#de all the essential doc#ments. If at least one essential doc#ment is not pro&ided( %o#r application will $e
a#tomaticall% reGected.
copies of $irth certificate or e#i&alent <es /A
proof citi)enship i.e. KTP or %o#r passport personal information pages <es /A
c#rrent C#rric#l#m Bitae <es /A
official 0certi$ied) & postsecondar% and tertiar% certi$icatesde"rees <es /A
official 0certi$ied) & postsecondar% and tertiar% transcripts of res#lts <es /A
c#rrent 0ori"inal1 /87S or 7/F8 'nglish lang#age test res#lts 0a test res#lt o$tained
in 7=67 or 7=6- will $e considered c#rrent1. 7/F8 prediction test is 7accepted.
<es /A
asters applicants m#st also attach certified DIII degree certificate and transcript if
#sing DIB or S6 e+tension certificate/transcript
<es /A
Doctorate applicants m#st also attach certified S6 degree certificate and transcript <es /A
academic reference from S7 s#per&isor for Doctorate candidates <es /A
Doctorate and those asters applicants whose st#d% will incl#de at least fift% percent
research must fill the research proposal details on page 6> of this application form<es /A
+dditional Documents= *ptional&
Applicants m#st pro&ide the following doc#ments if the% are selected for an inter&iew.
recent photograph 0- + 1 <es /A
official 0certi$ied) 1 /n"lis% translations of postsecondar% and tertiar%
certificates/degrees<es /A
official 0certi$ied) 1 /n"lis% translations of postsecondar% and tertiar% transcripts ofres#lts
<es /A
references from S6 s#per&isor for asters candidates 0if a&aila$le1 <es /A
list of rele&ant p#$lications( #np#$lished theses 0for research applicants1 <es /A
statement from #ni&ersit% that 'nglish is a lang#age of instr#ction 0if applica$le1 <es /A
rele&ant correspondence with an A#stralian #ni&ersit% 0if a&aila$le1. <es /A
official 0certi$ied,1 /n"lis% translations of $irth certificate <es /A
!P7+7=
• +ttac% only certi$ied copies o$ documents. D 7 attac% ori"inal documents.
• +pplication $orms and documents ill not be returned.
In section 77( 7- and 7 %o# will $e agreeing to important conditions attached to %o#r award and %o#r st#d% in A#stralia.*ail#re to compl% with these conditions will mean that %o# ma% inc#r a de$t to the 2o&ernment of A#stralia and %o#rscholarship ma% $e terminated.
D! !T sign the declaration at the end of section 7- and 7 #ntil %o# f#ll% #nderstand the conditions of the scholarship
award. If %o# ha&e an% pro$lems #nderstanding Section 77( 7- and 7 %o# are strongl% ad&ised to see@ clarification ofthese conditions from the A#stralia Awards !ffice.
If %o# are offered a scholarship %o# will $e as@ed to agree to certain conditions $efore accepting the scholarship. The mainconditions are set o#t $elow for %o#r information.
In accepting an A#stralia Awards Scholarship( %o# will $e as@ed to:
• ta@e #p the AUSTRALIA AWARDS SC!LARSI"S in the academic %ear for which it is offered
• complete a f#ll st#d% program d#ring the co#rse of their scholarship
• not hold another A#stralian 2o&ernment scholarship at the same time as the AUSTRALIA AWARDS
SC!LARSI"S
• participate in the "reDepart#re 4riefing arranged $% the "ost( and the #ni&ersit%Fs comp#lsor% Introd#ctor%Academic "rogram 0IA"1 on arri&al in A#stralia
• reside in A#stralia for the d#ration of the AUSTRALIA AWARDS SC!LARSI"S 0apart from holida%s( re#nion
&isits or fieldwor@ &isits to their home co#ntr%1
• complete their AUSTRALIA AWARDS SC!LARSI"S award within the period stip#lated in their St#dent
Contract
• onl% #nderta@e the appro&ed program for which the AUSTRALIA AWARDS SC!LARSI"S is offered and
a$ide $% the r#les of the #ni&ersit%
• maintain an appropriate st#d% load and achie&e satisfactor% academic progress in the program for which the
AUSTRALIA AWARDS SC!LARSI"S was offered
• participate in all acti&ities associated with the appro&ed co#rse of st#d%( incl#ding all lect#res and t#torials(s#$mit all wor@ re#ired for the co#rse 0e.g. assignments or essa%s1 and sit for e+aminations
• not #nderta@e an% additional offscholarship tertiar% st#dies d#ring their time in A#stralia on an A#sAID St#dent
Bisa
• $e aware that an% emplo%ment #nderta@en d#ring term times ma% compromise academic progress
• liaise with the St#dent Contact !fficer at the #ni&ersit% regarding an% proposed changes to the appro&ed
program and ac@nowledge that appro&al is re#ired from the #ni&ersit%( A#sAID and "artner 2o&ernment $eforean% changes are made
• agree to A#sAID collecting information concerning the St#dent or dependants and passing that information on to
other rele&ant parties( if necessar%
• ad&ise A#sAID immediatel%( &ia the St#dent Contact !fficer at the #ni&ersit%( if the% marr% a person who is an
A#stralian or ew ;ealand citi)en( or who has permanent residence stat#s in A#stralia or ew ;ealand. Thechange in a st#dentFs marital stat#s ma% affect eligi$ilit% to maintain the AUSTRALIA AWARDSSC!LARSI"S( and the De$t to the Commonwealth ma% appl% if the st#dent does not ret#rn to their homeco#ntr% for a period of 7 %ears
• ret#rn to their co#ntr% of citi)enship for two %ears at the completion of their st#d%/research program in A#stralia.
• $e aware that a De$t to the Commonwealth of A#stralia will $e inc#rred if a St#dent fails to ret#rn to their home
co#ntr%( or if the% appl% for "ermanent Residence or for a &isa to remain in or ret#rn to A#stralia within the two%ear period and
• that an% time spent in A#stralia d#ring the two %ear ret#rn home period will accordingl% e+tend the end date of
the two %ear periodagree that their AUSTRALIA AWARDS SC!LARSI"S ma% $e terminated at an% time for fail#re to ma@esatisfactor% academic progress( fail#re to compl% with the laws of A#stralia( miscond#ct( $reaches of the contract$etween the St#dent and the Commonwealth of A#stralia incl#ding $reaches of the conditions of the AUSTRALIA
airport closest to the A#stralian #ni&ersit% selected for st#d% $% the recipient
• #erseas Student ealt% Co#er *SC& recipient onl% 0recipients are re#ired to maintain !SC for an%
accompan%ing famil% in order to satisf% &isa re#irements1.
• /stablis%ment +lloance pa%a$le into the recipientFs $an@ acco#nt after arri&al in A#stralia
• Contribution to 8i#in" /Apenses *in +ustralia Stipend& pa%ment of a fortnightl% contri$#tion to li&ing
e+penses 0CL'1.
• ntroductory +cademic Pro"ram *+P& for a period of H wee@s #nderta@en prior to the commencement of
asters or "hD st#dies
• !asters !R P%D 7uition Fees incl#ding all comp#lsor% fees for the co#rse in which the recipient is accepted
into
• Supplementary +cademic Support pro&ided where it is deemed essential to assist recipients to pass co#rse
s#$Gects.
• Fieldor( holders of a scholarship where research comprises at least >= percent of the program ma% recei&e a
ret#rn econom% class airfare to Indonesia to #nderta@e essential fieldwor@.
• eunion +ir$are is a&aila$le to a KsingleF recipient after the s#ccessf#l completion of the first %ear of st#d%
s#$se#ent re#nion airfare entitlements will $e a&aila$le on an ann#al $asis for the d#ration of the AUSTRALIAAWARDS SC!LARSI"S( e+cept for the final %ear of the AUSTRALIA AWARDS SC!LARSI"S.
• omeard +ir$are 0econom% one wa%1 from the international airport closest to the A#stralian #ni&ersit%
selected for st#d% $% the recipient to the airport closest to the recipientFs home location.
<o#r #ni&ersit% will pro&ide for:
• instr#ction and facilities necessar% to complete the specified co#rse
• appropriate academic and welfare s#pport for the d#ration of %o#r st#dies
• airport reception and temporar% accommodation arrangements on arri&al in A#stralia.
04: to $e completed $% the staff mem$er within %o#r organisation a#thorised to release staff for o&erseas st#d% fore+ample staff from the International Relations 4#rea# 045L1 / Centre for 'd#cation and Training / the "lanning 4#rea# /Rector from the #ni&ersit% as appropriate. Applicants from o#tside a@arta m#st ha&e the appro&al and nomination of theirrele&ant 5a@anwil or 5adinas and appro&al from 4#pati or 2o&ernor 0or representati&e1 where necessar%.1
"lease note that %o#r signat#re on this form signifies %o#r agreement to the following:
• to release the applicant from wor@ d#ties while he/she attends 'nglish for academic training. This training is f#ll
time and comp#lsor%
•
to release the applicant from wor@ d#ties after 'nglish for academic training to st#d% in A#stralia( and processtheir official passport and e+it permit
• to co&er the cost of tra&el to and from 'nglish for Academic "#rposes training 04ali/a@arta1
• to co&er the cost of tra&el to the point of depart#re 04ali/a@arta1 prior to tra&el to A#stralia to co&er the cost of
medical e+aminations for the applicant. A medical e+amination is an A#stralian Immigration re#irement torecei&e a st#dent &isa
• to select a field of st#d% and le&el of st#d% appropriate to the agenc%Ps needs.
"lease also note that if the application is for Doctorate le&el st#d%( the signat#re $% the a#thorised staff mem$er confirmsthat the applicant is a lect#rer/researcher/@e% planner or polic% ma@er and that Doctorate le&el st#dies are essential forhis/her f#t#re research and /or teaching responsi$ilities.
A#sAID m#st compl% with the Privacy Act HFF in relation to the personal information %o# ha&e pro&ided in this form.
4% s#$mitting this form I a#thorise A#sAID( or its appointed managing contractor( to access and/or o$tain information(incl#ding copies of an% of m% rele&ant academic records/reports from the A#stralian Uni&ersit%0s1 that I ha&e attended forthe following p#rposes:
• for #se in the selection process for an A#stralia Award
• to monitor m% academic performance at m% host #ni&ersit% while st#d%ing #nder an A#stralia Awards
Scholarships
• to $rief rele&ant A#stralian officials( inisters and mem$ers of "arliament.
Sho#ld I recei&e an A#stralia Award( I consent to the A#stralian 2o&ernment #sing and disclosing e+tracts of m%application 0relating to m% academic $ac@gro#nd and achie&ements( leadership s@ills and m% proposed st#d% program inA#stralia1 in promotional material in hardcop% and on the Internet. I note that promotional material ma% incl#de( $#t is notlimited to( media releases and information circ#lated to A#sAIDFs offshore "osts and A#stralian #ni&ersities( concerning theA#stralia Awards Scholarships.
I a#thorise A#sAID to disclose the personal information collected in this form to other A#stralian 2o&ernment departmentsfor the p#rpose of promoting and managing the A#stralia Awards Scholarship.
6nderstandin"
I #nderstand and confirm that:
• I ha&e read and complied with the Scholarships and$oo@ and that the contents of m% application are tr#e and
correct
• A#sAID has the right to &ar% or re&erse an% decision regarding an A#stralia Awards Scholarships made on the
$asis of incorrect or incomplete information
• Decisions of the selection panel are final and confidential and no correspondence a$o#t o#tcomes of the
selection process will $e entered into.
+"reement
If s#ccessf#l in gaining an A#stralia Scholarships( I agree that I will:• #ndergo a police or character chec@ $efore m% A#stralia Awards Scholarships is confirmed
• immediatel% pro&ide A#sAID with details of an% incident that ma% reflect $adl% on the prestige of an A#stralia
Awards Scholarships
• act in a manner $efitting a recipient of an A#stralia Awards Scholarships
• #se the f#nds for the p#rposes granted
• ac@nowledge the assistance gi&en $% the A#stralian 2o&ernment in an% written reports( p#$lications or p#$licit%
associated with the Scholarships.
Declaration and ac(noled"ement
I declare( in s#$mitting this application form( that the information contained in it and pro&ided in connection with it is tr#eand correct.
ac(noled"e t%at "i#in" $alse or misleadin" in$ormation is a serious o$$ence under t%e Criminal Code Act 1995 o$ t%e Commonealt% o$ +ustralia.
*#ll ame Signat#re Date
/ /
25. !inistry o$ State Secretariat o$ t%e epublic o$ ndonesia use only
