2013 australia awards application form 20120203163037

8/2/2019 2013 Australia Awards Application Form 20120203163037

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Australian Development Awards for Pakistan - 2013 intake

SELF ASSESSMENT FORM FOR ELIGIBILITY

Which Scholarship you are applying for?

(Description on type of scholarships is available onAustralian Development

Scholarship

Australia Pakistan AgricultureScholarships

Which Profile are you applying under?

(Description on Profiles under which you can apply Profile 1 Profile 2 Profile 3 Profile 4

Do you also want to be considered for a supplementary AustralianLeadership Awards (ALA) Scholarship? (Details on ALA is available on

www.ausaid.gov.au/scholar/ala.cfm )

YES NO

Checklist

YES NO

1. Are you a Pakistani national?2. Do you have permanent residence in Australia or New Zealand?3. Are you married or engaged to a person who is eligible to hold Australian or New

Zealand citizenship or permanent residence?4. Have you been selected for any other government or foreign scholarship?5. 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, pleasecontinue

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?10.

Do you have at least two years of work experience after your16 years of

education?11.

If you are applying for a Masters by research degree, have you attached an outline

of the proposed research project (up to 1000 words)?12.

Will you be 45 years or older on 6 April 2012?

Please proceed with main Application Form only if you have answered YES for Qs. 6, 78, 9, 10 & 11 and, No for Q. 12.13.

Do you have a current IELTS score (test taken after 31st Jan 2011)?(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)

Please provide overall score and test date

14.

Are you living with a disability or working for people living with disabilities?

1 Gender Female Male

THIS DOCUMENT IS NOT FOR SALE
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5.

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 andcomplete and made in good faith. I understand that giving false or fraudulent information is a criminal offence and are grounds fordisqualification 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 DATE OF BIRTH

SIGNATURE DATE



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Application Form InstructionsPlease use BLOCK LETTERS and BLACK INK

> Applicants must complete all sections.

> This application must be completed in English.

> For Yes or No questions, indicate your response with an X in the appropriate box.> 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.Australian Development Awards (ADA) OfficeLevel 4, Serena Business Complex,Khayaban e Suharwardy, G-5/1, Islamabad.

> Please write the profile number, under which you are applying, on the top right corner of your

envelope.

> DO NOT send this application to universities or other education institutions in Australia.

> Awards are offered to Pakistani Candidates whose proposed course of study will

contribute to the long term development needs of the country. It is important to choose a

course that is a priority sector. A list of the priority sectors of study is available from the ADA-

Pakistan office in Islamabad or from the website (http://www.adspakistan.com.pk).

> ADA website includes a full list of Australian education institutions that accept AusAID scholars.

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 should choose two preferences of Master level courses offered by Australian institutions.

The courses should be at different institutions. Note that IELTS requirements for a course varieswith different universities and may be greater than AusAIDs requirement given below.

> Applicants are encouraged to apply through their current organization; however they can also

apply directly.> Ensure that each set of three (3) applications is presented neatly and professionally on A4 paper,

vertically secured together in the following order:a. feedback formb. self-assessment formc. three passport sized photos of applicantd. application forme. attested copy of IELTS score sheet(mandatory for profile 4 Candidates. Profile 1,2 & 3 candidates may

provide copy of their current IELTS score card if available)

f. attested1 copies of academic qualifications (all degrees and all transcripts)g. attested copies of Employment letters specifying years of service and job description (for

all years of employment);h. attested copy of passport or National Identity Card.

> If your Australian Development Awards application is successful, you will be required to sign a

Contract with the Commonwealth of Australia and be bound by conditions of the Australia Award.

A full list of the Australia Award conditions is contained in the Scholarship Handbook, available for

1 Attestation should include organisations stamp, date, signature and remarks like, 'This is a true copy ofthe original',


Photo1.5 X 1.5
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download on the ADS-Pakistan website. Please note that ADA reserves the right to change these

conditions at any time without prior notice.

> Submitting this application does not guarantee that you will receive a scholarship.

General Eligibility Criteria

Applicants must meet all of the Australia Awards general eligibility criteria. These include: be Pakistani citizens (dual nationals are not eligible); be currently residing in Pakistan; not have applied for or hold permanent residency 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 residence; satisfy Australian Government requirements for international student visas for entry to Australia

(heath, character etc.); be able to provide a Police Security Clearance certificate at the time of Visa application;; not hold another scholarship; 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); 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); be able to take up the scholarship in the year for which it is offered; have outlined a case that is clear about their objectives and motivation to make a contribution to

development in Pakistan; be not more than 45 years of age at the time of application. have completed 16 years of education; 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); be applying for a Masters level course;

be applying for courses that fall within the priority sectors identified on the ADA-P website givenbelow;

satisfy the admission requirements of the Australian tertiary institution and the course to beundertaken;

have a relevant academic background to proposed study in Australia; be able to demonstrate the ability to meet the English Language Proficiency requirements for the

Scholarship; at the time of application candidates applying under Profile 4 must have a current IELTS score of 7

with no band less than 6; candidates applying under Profile 1, 2 & 3 do not need to provide a current IELTS score at the time

of application; however, candidates successful in preliminary screening with no current IELTS score,will be required to take an IELTS test on short notice (an IELTS score of 6.5 with no band less than 6is required for eligibility);

have at least 2 years work experience in the field in which they are applying (5 years experience isrequired for applicants falling under profile 2); and

must return to his/her home country to take up a position that utilises his/her study for a minimumperiod of two years.

Useful Australian Websites

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

http://www.immi.gov.au/http://www.immi.gov.au/


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For information about other Australian Government Scholarships (Australia Awards):

http://www.australiaawards.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

For information on Australian Development Awards in Pakistan http://www.adspakistan.com.pk

For information on the Scholarships Handbook http://www.ausaid.gov.au/scholar/studyin.cfm


1.Personal Details

Title

Mr Mrs Ms Dr

Other Please specify

Family Name (as shown on Passport /

Given Names (as shown on Passport /

Date of Birth / /

Gender Female

Country of Citizenship Do you have Dual Yes No

Passport No.**If you are waiting for a Passport to be issued, Copy of your Passport

should be made available to the ADA office in the country you are

Issue Date: / /

Expiry Date: / /

Are you living with a disability or working with people who arelivin with a disabilit ?

Yes No

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 (To be complete d by ADA Office

ADA No.. Satisfies Country SpecificSelection Criteria

Yes

NoOASIS ID.

First PreferenceCourse Name

Course CRICOS Code

Institution/University

Course Type Coursework Research

Second PreferenceCourse Name

Course CRICOS Code

http://www.australiaawards.gov.au/http://www.studyinaustralia.gov.au/http://cricos.dest.gov.au/http://www.adspakistan.com.pk/http://www.ausaid.gov.au/scholar/studyin.cfmhttp://www.australiaawards.gov.au/http://www.studyinaustralia.gov.au/http://cricos.dest.gov.au/http://www.adspakistan.com.pk/http://www.ausaid.gov.au/scholar/studyin.cfmhttp://www.adspakistan.com.pk/


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Course Type Coursework Research

IELTS ScoresOverall Listening Reading WritingSpeaking

2.Eligibility for an Australian Scholarship

What is your country of citizenship?

Are you currently residing in your

country of citizenship?

Yes (for how long)

Years

Mo

If not, in which country are you

residingCountry Name

(for how long) Years

Have you studied overseas in the

past?Yes No

If Yes, provide detailsCourse title:

Degree obtained:

Duration:

Year completed:

Country:

Have you applied for permanent

residence in Australia or New Zealand?Yes No

Are you entitled to Australian or NewZealand permanent residence or

Yes No

Excluding holidays or other short

visits, have you been granted

temporary residence status in

Australia?

Yes

NoVisa no.

Have you held any Australian

Government scholarships in the past?Yes No

If Yes, provide

details Name of Scholarship:

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



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If Yes, provide

details Name of Scholarship:

Granted by:

Start date:

End date:

Course Completed:Country where study Completed:

3.Contact Details

Once submitted, this scholarship application takes several months to be finalised. Pleaserovide an address where ou can be contacted when a decision is reached.

Current residential address

Address line 1

Address line 2

Town/City Postal code

State/Province Country

Home phone no. Work phone

Mobile no. Fax no. (if any)

Email 1

Email 2 (if any)

Mailing address Provide details only if different from your current residential

Address line 1

Address line 2

Address line 3



Emergency Contact Details (person to

Name

Relationship to

Address line 1

Address line 2



Home phone no. Work phone

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 foraccompanying dependants.

Family nameProvide family name andother names as shown in yourspouses passport or otherofficial identification

Given names

Gender Male Female Date of / /

Country of

Passport no.Provide if spouse has a

Issue Date: / /

Ex ir Date: / /

Will your spouse accompany you to Australia? Yes No

(Reunion airfare is included or excluded from the scholarships offer based on this clause. See ADA

5.Children Details (attach a

Child 1 Will this child accompany you to Australia?

Family name

Given names


Country of

Passport no.

Provide if child has a

Issue Date: / /

Expiry Date: / /


Family name

Given names


Country of

Passport no.Provide if child has a

Issue Date: / /

Expiry Date: / /


Family name

Given names


Country of

Passport no.Provide if child has a

Issue Date: / /

Expiry Date: / /



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6.English Language Proficiency

Is English your first language? Yes No

If No, please answer the following:

Have you taken an IELTS test? Yes No

IELTS Scores

(For profile 4 Candidates, IELTS

score of 7 with no band less than 6

is a mandatory requirement for ADA

application. For Profile 1,2 & 3

candidates, may provide details, if

available*)

Date testtaken

/ /

Overall Score

Listening Reading WritingSpeaking

Give details of any Englishlanguage trainingundertaken / currentlybeing undertaken.

*Note: After the preliminary screening, ADA will arrange IELTS test for those successful

applicants under profile 1,2 & 3 who have no current IELTS score.

7.Qualifications



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Past and Current Studies List by level of study, startingwith hi hest level

-Please include any studies you are currently undertaking and studies you havecompleted.-Certified copies of Degrees, transcripts (DMCs) and certificates must be included witheach application form.

-Any documents not in English must be translated and certified copies of English

1. Qualification

Level of study

Secondary SchoolCertificateHigher Secondary School

Certificate

Vocational, technicaldiploma/CertificatePostgraduate Diploma

Name of

Country

Language of

Status Start / / Completion / /

2. Qualification

Level of study


Certificate


Name of

Country

Language of


3. Qualification

Level of study


Certificate


Name of

Country

Language of


4. Qualification

Level of study

Secondary School Certificate

Higher Secondary SchoolCertificate

Vocational, technicaldiploma/Certificate

Postgraduate Diploma

Name of



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Country

Language of

Status(complete/inco

Start / / Completion / /

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

8.Proposed Study Program

ADA are offered to Pakistani Candidates whose proposed course of study willcontribute to the long term development needs of the country. It is important to choose acourse that falls under a priority sector as declared by ADA. A list of priority sectors is availablefrom the ADA websitewww.adspakistan.com.pk or in the advertisement published in Newspapersof 6th February 2011

ADA website includes a full list of Australian Institutions that accept ADA students. You need todecide which Institution you would like to attend and choose an appropriate course. To find outabout the content of specific courses, you should refer to the individual Institution websites.

You should choose two courses of study offered by ADA Institutions. The courses may be either at

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

Preference 1

Course Name

Course CRICOS Code (CRICOS code is a 7digit number


Course Type

Coursework Research

If you have chosen research, please attach two referee statementsand a research ro osal

Preference 2

Course Name

Course CRICOS Code (CRICOS code is a 7digit number


Course Type

Coursework Research

If you have chosen research, please attach two referee statements

and a research ro osal

9.Research Applicants

If you do not intend to undertake 50 per cent or more of your course by

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All Master level applicants whose study program will include at least 50 percent research MUST attach an outline of the proposed research project (up to1000 words) to each application form. The outline should address thefollowing:

> 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 estimatedschedule for completion and each step in research and thesis writing.

You MUST also attach 2 references in support of your application for aresearch ADA.

If you have already applied to an eligible ADA Institution or had

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

If Yes, please give details (only one fieldwork trip within Australia or to your country of

1.Special Requirements

Are there any special requirements which you mayneed to complete your study program in Australia(eg wheelchair access)?

Yes No

If Yes, please give details:(Note: the details will not adversely affect your application)

2.Applicants Supporting Statement



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Please limit your answers to 100 words per question. Attach a page if there is notenough room.

The answers must be in the applicants own words. It is unethical to plagiarise, paraphrase, copy or

quote without citing the source. All such applications will be immediately ruled out.

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 inAustralia? 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 applicationfor this scholarship?



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3.Employment History (in

Current employment Provide details if currently

Position title

Starting date / /Employing

Brief description ofyour duties andresponsibilities(maximum 200words)

Will you be returning to this position after your Yes No

If No, what type ofemployment doyou hope to gain

after your studies?(maximum 100words)

Previous position 1 Provide details if previously

Position title

Starting date / / Finishing date / /

Employing

Brief description ofyour duties and

responsibilities(maximum 100words)

Previous position 2 Provide details if previously

Position title

Starting date / / Finishing date / /

Employing

Brief description ofyour duties andresponsibilities

(maximum 100words)



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13 a. Employer and Nominating Authority Statement

Are you applying Under profile1 or 2 ?

Yes (Please provide following details)

No (Go to 13 b)

Support of the nominating/coordinating authorityTo be completed by all public sector applicants only in English by an authorised officer from the

nominatin /coordinatin authorit .

How will the applicants selection assist your countrys development goals?

On behalf of the Government of Ideclare that I have examined the documents attached to this form and amsatisfied that they are authentic and relate to the applicant. I agree that thelevel and field of study, and length of scholarship and fieldwork proposed inthis application are appropriate and in accordance with the Governments

I nominate for

Name ofnominatingauthority

Title

Organisation

Contactdetails

Signature OfficialStamp



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Date / /

13 b. Employer and Nominating Authority Statement

Are you applying through yourorganization?

Yes (Please provide following details )

No (Please go to 14)

Support of the applicants employer/supervisorTo be completed in English by an authorised officer from your organisation/employer.

Nominated by (name of

Please indicate the specific skills and capacities (not the qualification) youwould expect the applicant to gain from the proposed study program:

Name Position

Contactdetails

Signature OfficialStamp

Date / /



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14. Documentary Evidence

Please note:> Applications with incomplete supporting documentation will be rejected.> Three HARDCOPIES of the application form are required.

> EACH copy of the application form should have certified* copies attached of therelevant documents listed below (where applicable).

> Where original documents are not in English, applicants must provide certified*copies of English translations.

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

A. All Applicants:

Copy of passport personal information pages and/or ID Card Yes No

IELTS English language test results. Yes No

Statement from last attended university or school that English is

the language of instruction Yes No

Curriculum Vitae or details about relevant employment Yes No

One copy of the self-assessment form for eligibility to beattached on top of the three application forms

Yes No

Recent passport size photographs affixed to the three copies ofthe application form

Yes No

Employment letters specifying years of service and jobdescription (for all jobs/ years of employment)

Yes No

B. Academic Documents:

Certified copies of official transcript for Matriculation or O Levels(Secondary School Certificate)

Yes No

Certified copies of official transcript for Intermediate or A Levels(Higher Secondary School Certificate)

Yes No

Certified copies of official transcript and degree for Bachelorslevel study (Undergraduate)

Yes No

Certified copies of official transcript and degree for Masters levelstudy (Postgraduate) (If applicable)

Yes No

Certified copies of official transcript and certificate / diploma fortechnical / vocational study (If applicable)

Yes No

Official English translations of all academic transcripts anddegrees (if applicable)

Yes No

C. Research Applicants Only:

Outline of proposed research project (for details see Section 9) Yes NAReferences from two academic referees (if not available, pleaseexplain why)

Yes NA

List of relevant publications and unpublished thesis Yes NA

D. Other

Any other relevant documentation in support of your ADAapplication

Yes NA

Please list:



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1.Applicants Authorisation, Agreement, Declaration And Signature

ADA is authorised to collect all items of information in this form underthe Australia Awards which includes Australian Leadership AwardsScholarships/Fellowships and Australian Development Scholarships, andis bound by the requirements of the Privacy Act 1988 of theCommonwealth of Australia.



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AuthorisationI authorise AusAID, and/or its appointed managing contractor, hereafter theADA, to obtain copies of any of my relevant academic records/reports from theeducational institution(s) that I have attended for purposes relating to myapplication for an Australian scholarship including:

> For use in the selection process;> To monitor my academic performance at my host education institution if I am

awarded the scholarship;> To brief relevant Australian officials, Ministers and members of Parliament.

Should I receive an Australian Development Scholarship, I consent to theAustralian Government using and disclosing extracts of my application (relating tomy academic background and achievements, leadership skills and my proposedstudy programme in Australia) in promotional material in hardcopy and on theInternet. Promotional material may include, but is not limited to, media releasesand information circulated to ADAs offshore counsellors and Australian educationinstitutions, concerning the Australia Awards.

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.

I authorise ADA to advise other Australian Government departments participatingin the Australia Awardsprogramme of my scholarship application.UnderstandingI understand and confirm that:> I have read and complied with the instructions to applicants and the contents

of my application are true and correct;> ADA 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 enteredinto.

AgreementIf successful in gaining an Australian scholarship, I agree that I will:> Immediately provide ADA with details of any incident that may reflect badly on

the prestige of Australian Development Scholarship;> Authorise a third party to conduct my Police Security Clearance on behalf of

AusAID;> 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 acknowledgementI declare in submitting this application form that the information contained in itand provided in connection with this application is true and correct.

I acknowledge that giving false or misleading information is a seriousoffence under the Criminal Code Act 1995 of the Commonwealth ofAustralia.

Name (title, given names,family name)

Signature Date

/ /