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Australia Awards Scholarships in Papua New Guinea 2017 Intake e-Application Form

Instructions Before completing this application, you must read the Australia Awards Scholarships Policy Handbook (Handbook) and the Papua New Guinea Country Profile, available on the Australian Government, Department of Foreign Affairs and Trade (DFAT) website or from the Australia Awards Facility – PNG (AAPNG) website.

This application must be completed in English and it is preferred that applications are completed and submitted electronically.

Do NOT… wait until the last minute to prepare your application. Early preparation and good planning are key to a

successful application.

provide false statements and claims in your application. Doing so may be regarded as fraudulent.

apply directly and do not send the completed application to Australian Universities. This is a separate process that will be commenced once you get an award.

exceed space limits when completing the application.

resign from your job until you receive a signed offer letter from the Australian Government, Department of Foreign Affairs and Trade.

apply if you do not satisfy the eligibility requirements (refer to Part I for details).

Additional Notes… Scholarships will be offered only to those whose course of study will contribute to the long-term development needs of Papua New Guinea. A list of the development priorities is available from the AAPNG website.

You may provide two preferences for courses of study. You should consider two similar courses from two different institutions rather than two courses at the same institution, just in case you do not meet the admission requirements of the first institution.

Failure to comply with application instructions or to complete the application in full, correctly, and honestly may result in your application being ineligible for consideration.

If your application is successful, you will be required to sign a contract with the Commonwealth of Australia and be bound by the conditions of the scholarship. A full list of the conditions is contained in the Handbook. Please note that DFAT reserves the right to change these conditions.

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

For Public Servants applying under the PUBLIC CATEGORY, you need to work with your HR manager or the Department of Personnel Management (DPM) regarding the Overseas Learning and Development Bid. Only applicants with bids endorsed by the respective Agency and DPM will be assessed.

And Remember that… This application and all attached documents must be received by the Australia Awards – PNG Facility on or before:

29 February 2016 Late applications will not be considered

Australia Awards – PNG Facility Australia Awards Application Form: 2017 Intake ii

CONFIDENTIAL WHEN COMPLETED NOT FOR SALE

To complete the e-Application form: Copy the application to your hard disk, flash drive or USB. Do NOT edit it directly from your email.

Open this application using Adobe Reader XI or Adobe Reader DC. (Note: Earlier versions of Adobe Reader cannot be used. However, you can use any version of Adobe Acrobat Standard or Professional. Other PDF viewer programs may give incorrect results. Adobe Reader DC is available from https://get.adobe.com/reader.)

Answer ALL the questions in Part 1 regarding Eligibility. If you are not eligible for any of the reasons listed, your application cannot be considered. If you do not complete Part 1 in full, your Application will be considered NON-COMPLIANT.

Complete ALL the required details in ENGLISH. Applications that are not complete or not in ENGLISH will be considered NON-COMPLIANT and not assessed further.

You can use the Submission Checklist at the end of this form to make sure you have completed all required fields.

To submit your application: Once you have confirmed that the application is complete, save the filled-in application form to your

hard disk or to a Flash drive. (In Acrobat Reader XI or DC, save the form using File->Save from the Reader menu.)

Close the application, then open your saved copy to verify that all your information is saved.

Attach the saved file to a new email message. Send the email to [email protected] using your registered email address (i.e. the email address you provided in this application).

You may also submit your application using the Submit Application option in the Submission Checklist at the end of this form.

Submitting Supporting Documents Supporting documents must be emailed in electronic format to [email protected]

Scan each supporting document to convert to an electronic file.

Give the scanned file a meaningful name that indicates its contents; e.g. ‘Academic Transcript’, ‘Passport’.

Attach the scanned file to an email message. Provide a meaningful subject line for the email, and send to [email protected] REMEMBER: Send ALL documents, using the contact email account you provide in the Personal Contacts of this application.

AFTER the form is filled in, print these pages:

- Current Employer’s Statement, Endorsement and Signature (pages 27, 28 and 29) - Applicant’s Declaration and Signature (p 30)

Have your employer sign and date the Current Employer’s Endorsement and Signature page.

Sign and date the Applicant’s Declaration and Signature page.

Scan the printed and signed pages.

Email the scanned signed documents to [email protected] using your registered email account.

We recommend you use the Submission Check List at the end of the application form to submit and keep track of your supporting documents.

Australia Awards – PNG Facility Australia Awards Application Form: 2017 Intake iii


Frequently Asked Questions Can I print and scan the e-Application, then send the whole application scanned?

No. Print, scan and sign only the Current Employer’s Endorsement and Signature and Applicant’s Declaration and Signature pages, as explained above. Save the filled-in application, then send the saved file.

I use a Mac. How do I complete the form?

For best results, complete the form using Adobe Reader XI for the Mac. Preview may be used if you do not have access to Adobe Reader; however some interactive functions will not work.

Can I complete the form on my tablet or phone?

No. For now, Adobe Reader Mobile for Android and Adobe Reader Mobile for iOS do not allow you to save a filled-in secured form.

Can I send all my documents in one email?

You can send as many documents on one email as you like, provided the total size is not over 20Mb. You may also send as many separate email messages as you like, provided they are all sent using your registered email account.

Can I "zip” my documents?

Yes, you can compress your documents as ZIP or RAR format archives. This may reduce the size of the files and make them easier to send. You may include as many files in a single archive as you wish.

My documents are on my sky-drive. Can I just send you the link?

No. We do not accept documents submitted as links to any skydrive, dropbox or other internet location. The document must be submitted as an attachment to an email message.

If I need to supply extra information, can I just provided it in the body of the email?

No. Messages sent to [email protected] are automatically processed to extract the attached documents, and are not read by our staff.

For more information on completing the application, refer to: http://www.scholarshipspng.org/formrequest/technical_tips_and_advice.pdf

If you have any questions about Australia Awards Scholarships, including the application process, refer to the information on the websites below in the first instance, and if necessary contact Australia Awards – PNG Facility by email ([email protected]).

Useful websites Australia Awards: http://www.australiaawards.gov.au

DFAT: http://www.dfat.gov.au/aid

Australia Awards - PNG Facility (AAPNG): www.australiaawardspng.org

Visas – Department of Immigration and Border Protection: http://www.immi.gov.au

Studying in Australia: http://www.studyinaustralia.gov.au

CRICOS: http://cricos.education.gov.au

IELTS: http://www.ielts.org

TOEFL: http://www.ets.org/toefl

PEARSON: http://www.pearsonpte.com

Enquiries: [email protected]

Applications should be sent to: [email protected]

Australia Awards – PNG Facility Australia Awards Application Form: 2017 Intake 1


PART 1: About You

This section collects your personal details and allows you to determine your eligibility for an Australia Award. Any false statement will result in rejection.

Eligibility Are you a citizen of Papua New Guinea?

Yes

No – not eligible. Do not proceed.

Do you intend to live in Papua New Guinea during the year 2016?

Yes


Will you be 18 years or older in 2016?

Yes


Do you, your spouse or your partner, currently have or are eligible to apply for citizenship or permanent residency in Australia?

Yes – not eligible. Do not proceed.

No

Do you have at least two years of work experience relevant to the field in which you propose to study?

Yes

No– not eligible. Do not proceed.

Are you a member of the PNG Defence Force?


No

Have you held a long-term Australian Government Scholarship previously and have you been in PNG since completion for a period less than twice the duration of the Scholarship? (For example, you held a Scholarship for 2 years, and returned to PNG less than 4 years ago.)


No.

Will your proposed course of study lead to a qualification at the same level as a qualification you already hold? (For example, you propose to enroll in a Masters course, but you already hold a Masters degree.)

Yes – not eligible. Do not proceed. Your proposed study must be at a higher academic level.

No

Have you ever been subject to any criminal or civil proceedings, an internal investigation or are you currently facing legal action or police charges in any country?

Yes – This will not necessarily disqualify you.

No

If YES, please provide additional details:



Award Category Which Award Category are you applying for? Tick one only:

Open Category (All applicants may apply in this category)

I understand that as an Open Category applicant, I may have to resign from my employment or take leave without pay. The contribution to living expenses provided under the Award may need to be supplemented by my own savings.

Public Category (GoPNG public servants only)

To apply in the Public Category, you must be part of an Overseas Training Bid (in accordance with GoPNG General Order No 6) approved by your department and endorsed by the Secretary of the PNG Department of Personnel Management (DPM). The course details and priority sector you nominate in this application must conform to those endorsed in the Bid.

Public Category Applicants

Select your employer from this list. Be as specific as possible:

Please provide the Endsorsed Bid No (assigned by DPM and provided to you on confirmation of your Bid) and your Payroll No here:

GoPNG Endorsed Bid No (if available):

GoPNG Payroll No:

Personal Information Title Mr Mrs Ms Miss Dr

First Name / Given Name

Middle Name (if applicable)

Surname / Family Name

Enter your Family Name and other names as shown in

your Birth Certificate, Passport or other official

identification Document

Date of Birth

Current Age

Sex Male Female

Primary Province of Origin

(i.e. identity, culture)

Passport number - (provide if you have a passport). Issue date

Expiry date



Personal Contact Details The application process takes several months and you must be contactable at all times. If you are not contactable or unresponsive your application may be disqualified.

Residential Address

The address where you live. Do NOT

specify a PO Box or postal address.

Town / City Post Code

District of Residence

Province of Residence

Home Phone Number Main: Other:

Work Phone Number Fax:

Mobile (Cell Phone) Number Main: Other:

Email Address For all communication with Australia Awards – PNG Facility. This must be an email address to which only you have access:

Postal Address Postal address may be required if your application is successful. Leave blank if same as residential address..

Address or PO Box

Town / City Postal Code

Province

Country

Dependants You are responsible for supporting your dependants (spouse and children under 18 years of age) whether they remain in PNG or accompany you on-award in Australia. The Award does not provide additional financial support for your dependants. Family entry to Australia is subject to Australian Immigration requirements including evidence of financial status (refer to the Department of Immigration and Border Protection website for details). If you do not have sufficient funds to support your dependants and qualify for an Australian visa then you should not submit an application.

Financial Declaration:

I have reviewed the financial requirements for a student visa and I believe that, having regard to the contribution to living expenses and my private savings that I have sufficient funds to support myself and my dependants and qualify for an Australian student visa.

Yes

No – not eligible. Do not proceed. You must be able to support your dependants.

Family status

Married Single with children Never Married Engaged

De facto relationship (have partner)

Divorced/ Separated



Dependant Details

Given Name Family Name Sex Date of Birth Relationship Accompanying

M F Yes No

Passport No: Issue Date: Expiry Date:

M F Yes No


M F Yes No


M F Yes No


M F Yes No


M F Yes No


M F Yes No


M F Yes No


Should you be given an Award and wish to take your dependants with you to Australia please outline your plan to support them including any travel to and from Australia.



Emergency Contact Details

Title Mr Mrs Ms Miss Dr

First Name / Given Name

Surname / Family Name

Relationship to you

Sex Male Female

Residential Address

Town / City Post Code

Province

Country

Phone Number Home: Mobile:

Work Phone Number Work Ph: Fax:

Email (Specify one email address only)

English Language Proficiency Refer to the Scholarships Policy Handbook, Country Profile and the institution for specific English Language requirements.

Is English your first Language? Yes No

Is English the language of your highest studies? Yes No

Have you taken an IELTS, TOEFL or PTE test? Yes No

Test Name Test Date

Overall Score

Reading Score Writing Score Listening Score Speaking Score

If you have not yet taken a test, enter the test you intend to take, and the expected date of that test:

Expected Test: when do you expect to complete the test?

Expected Test Date



Computer Literacy Please answer the following questions to the best of your ability. This will assist Institutions to decide whether to provide additional tuition.

How regularly do you use a PC? Daily Weekly Monthly Occasionally Never

Please rate your overall computer literacy:

Very good Moderate Weak None

Please indicate the software packages that you are familiar with:

Word processing software (e.g. MS Word)? Spreadsheet software (e.g. Excel)?

Database software (e.g. Access, EndNote)? Operating Systems (e.g. Windows 07)?

Presentation software (e.g. PowerPoint)? Email software (e.g. Outlook)

Internet browser (e.g. Internet Explorer)? Statistical packages (e.g. SPSS or Minitab)

Computer Training Provide details of any computer training courses you have undertaken.

Course Name:

Start date End date

Course Name:

Start date End date

Professional Memberships

List any relevant associations and organisations. These may be community, cultural, political, scientific, professional and/or educational organisations.

1. Association Name

Position

Start date End date

2. Association Name

Position

Start date End date

3. Association Name

Position

Start date End date



Previous Scholarships Have you previously received, or do you currently hold, a scholarship funded by PNG, Australia or another foreign country?

Yes

No

If YES, provide details:

Scholarship Name

Start Date End Date

Name of Institution

Study Country

Qualification Received

Have you previously applied for an Australian Government scholarship?

Yes

No

If YES, provide details

Other Scholarship Applications

Are you currently applying or considering applying for another scholarship funded by another country?

Yes

No

If YES, provide details

Scholarship Name #1

Likely Start Date Likely End Date

Name of Institution

Study Country

Qualification

Scholarship Name#2

Likely Start Date Likely End Date

Name of Institution

Study Country

Qualification



Disability Inclusion and Support DFAT strongly encourages applications from people living with a disability who are otherwise eligible for a scholarship. Under the Disability Discrimination Act, Australian education institutions have to provide 'reasonable adjustments' to students with disability to assist access to study. To assess the likely support needs, appropriate assistance, and the capacity of relevant institutions to provide the assistance, awardees with a disability/special need must provide details of the disability and/or special need when they accept their offer. This information is bound by Australian privacy laws and will be disclosed only for the purpose of facilitating an accessible barrier-free learning environment.

Modifications to physical or learning environments, including additional educational supports such as sign interpreters and captioning, may be available depending on the relevant Institution's capacity. DFAT will advise the Institution of any special requirements associated with an Awardee so that the Institution can pass these details to the Institution’s Disability Liaison Officer prior to the Awardee arriving on-campus. Where an Institution is not able to provide the assistance requested, other Institutions may be recommended.

Do you identify as having a disability? Yes No

Under Australian law, disability includes physical, intellectual, psychiatric, sensory, neurological, learning disabilities, physical disfigurement, and the presence in the body of disease-causing organisms

If you answered YES above, please provide details if you require special assistance or equipment to participate in the scholarship selection processes or to live and undertake studies in Australia:



PART 2: Reintegration

Reintegration is the process of returning to Papua New Guinea after completing your Australia Award Scholarship.

Reintegration planning is the process of preparing to apply skills and knowledge acquired on award to enhance your organisation or community and to impact the development of Papua New Guinea.

Using your skills and knowledge to impact development in PNG is the primary purpose of the Scholarship.

Your Reintegration Plan is an essential component in assessing your suitability for receiving an Australia Awards Scholarship. Assessment will take into account the relevance of your proposed plan to your current employment, and how you intend to apply your enhanced skills to advance your career, and contribute to achieving your employer’s HR objectives and Papua New Guinea’s development goals.

Applicants who demonstrate a consolidated reintegration planning approach in their applications are well positioned to “return the investment” of the Australia Awards in Papua New Guinea. By applying the skills and knowledge acquired from their studies, alumni can make contributions to the development of Papua New Guinea by improving policy, operations or enhancing services and governance practices in their employing agency or industry sector.

Current Employment Position title

Name of Employment Organisation

Start Date

Please describe your current employment

Executive / Senior Management/ Senior Professional (e.g. Senior Principal, Director of Nursing or Nurse Superintendent)

Middle Management/ Professional (e.g. Principal, Supervising Nurse Practitioner)

Senior Clerical or Administrative/ Technician/ Supervisory (e.g. Specialist or Supervising Teacher, Senior or Specialist Nurse)

Clerical or Administrative/ Tradesperson (e.g. Semi-skilled, Graduate entry Public Servants, Graduate Teachers and Nurses)

Trainee/ Unskilled (eg Apprentice or Intern)

Where do you work? (Note: for commuting or fly-in /fly-out workers, this may be different from the province in which you live.)

District in which you work:

Province in which you work:

What is your current Annual Income? Include the value of your cash income and any other benefits (such as housing, domestic support etc). Enter the value in PNG kina.

This information is used for statistical and program evaluation purposes only



Employer Contact Details

Name of General Manager

Physical Address (your actual work

unit and location):

Town / City:

Province Post Code

Country

Contact Phone Number Main: Other:

Mobile (Cell Phone) Number Main: Other:

Employer Email

Type of Organisation Public Sector (i.e. PNG Government)

Private Sector (i.e. private companies)

Civil Society (i.e. community, non-government organisation or faith based organisation)

Multilateral organisation or international aid agency or program

Sector of Employment What industry sector does your employer work in?

Select the sector in which your employer operates, not the sector of your profession.

Health

Construction

Energy Generation and Supply

Transport and Storage

Water Supply and Sanitation

Other Infrastructure

Government or Community Development (excluding Health, Education, Infrastructure and Economic Development)

Communications (IT, media)

Conflict Prevention, Resolution, Peace and Security

Humanitarian Aid

Environment

Multi-Sector and Cross-Cutting (including Urban and Rural Development and Science)

Higher Education & Research

Other Education

Banking and Financial Services

Business and other Services

Other Finance

Agriculture

Fishing

Forestry

Industry

Mineral Resources and Mining

Tourism

Trade Policy and Regulation

Other Economic Development

Other

If you answered “Other” above, please provide details:



Will you return to this employer when you complete your Award?

Yes No Not sure

If NO or NOT SURE, what are your plans when you finish your studies? (approximately 80-100 words limit).

Please provide your detailed employment history in the Curriculum Vitae in Part 4 of this form.

For your current position, or a position you have held within the last two years, you may supply any Performance Appraisals or summaries from your performance review process to support your application. Please do not submit more than three pages.



Reintegration Plan General Expectations - Outline your reintegration plan.

What skills gap or human resource need in your organisation, department or community will you address with this scholarship? Include an excerpt from your Strategic Plan or HR Work/Training Plan, organisational documents or needs analysis if possible.

(max 500 characters, Approx. 80-100 words limit)

Describe the policy, process or activity that you will use your qualification to improve. Be as specific as possible.

What problem needs to be addressed?:

What will your plan do?:

If the plan is successful, what change will occur?



All applicants must answer these questions (max 1000 characters, approx 200 words limit each question).

How will the proposed study contribute to your career?

How have you contributed to solving a challenge and to implementing change or reform? (Be specific and include: what aspect/s of your leadership knowledge, skills and practices you consider to be well established and effective; which people or organisations you worked with to solve the problem; and what creative methods were used.)



What specific development area will your reintegration plan contribute to on your return home?

Do you currently have any connection or relationship to any staff employed at DFAT Posts or Australia Awards – PNG Facility?

Yes No

If YES, please explain:

Is there anything else you would like to add?



Part 3: Proposed Studies

You need to ensure that the course of study you are considering supports the success of the Reintegration Plan you have described in Part 2 of this application. If you are successful in your Australia Awards Scholarship application, you will be assisted to choose the best course for you, at the most suitable institution for your needs. The assessment of your application will include consideration of your proposed studies.

Level of Study Indicate the level of study you wish to undertake.

Diploma

Undergraduate

Postgraduate (by coursework)

PhD/ Masters by Research (Prioritised for applicants currently employed in Higher Education and Research Institutions)

Australia Awards Scholarships seek to assist the development of Papua New Guinea by promoting studies in the priority sectors listed below. Please select the sector that best describes your proposed study program. Choose one entry only. Leave blank if none apply.

Priority Sectors

Health Education Health Management, Planning or Research

HIV AIDs, STIs and Sexual Health

Allied Health (Occupational Therapy, Physiotherapy, Speech Pathology)

Paediatrics

Nursing Management

Oncology

Age Care Nursing

Pathology

Radiography

Laboratory Science

Biomedical Engineering

Sonography

Curriculum Development and Teaching Methodologies (Basic, Secondary, TVET, Higher Education)

Education - Policy and Development

Specialist Teaching (Disabilities)

Student Guidance and Counselling

Teacher Education for Higher Education

Research or Teaching Research

Quality Assurance and Accreditation

Transport Land Development Civil or Maintenance Airports, Ports, Roads

Aviation: Airport Management, Security and Emergency, Air worthiness inspection and Certification (Non Flying)

Road Safety – Data Collection and Analysis, black Spot Audit, Management and Infrastructure Design

Infrastructure Planning

Design and Infrastructure

Regional and Town Planning

Cartography

Rural Development Economics Veterinary Science

Animal Husbandry

Economics (All Sectors)



Law and Justice Government and Community Development Public Prosecutions

Anti-Corruption

Legislative/Administrative Review and Investigations

Conflict Prevention, Resolution, Peace, Security

Public Law

Public Policy, Planning and research, Policy Analysis

Public Administration

Environmental Management

Public Sector Systems and Service Delivery (Management, Accounting, Audit and Implementation)

Tourism Promotion

Sustainable Development

Statistical and Performance Reporting Cross Cutting Fields of Study Economic and Social/Demography Survey

Statistical and Performance Reporting

Data Management and Analysis

Monitoring and Evaluation

Disability, Disability Studies and Teacher Training (Disability Specialisation)

Gender

Family and Sexual Violence

Generic Sectors Information Technology (All Disciplines)

Management Studies

Development Studies

Information and Communication Technology, Teaching and Learning

Project Management, Contract Supervision, Contract Management, Arbitration and Procurement Applying to all Sectors

Development Theme

What Development Theme will your studies support? Please tick one that is the most relevant.

Disability

Disaster risk reduction

Economic Growth

Education

Environment

Food Security

Gender Equality

Governance

Health, HIV/AIDS, pandemics

Human Rights

Infrastructure

Regional Stability

Water and Sanitation

Specialisation Will your planned studies include any of these specialisations? (Tick all that apply). If you are not planning to study in these fields please skip this question:

Disability related studies. Give details

HIV/AIDS related studies. Give details

Gender related studies. Give details



Course and University Choices Provide any preferences for the course and institution at which you wish to study. If you already know exactly which course you want to undertake, please provide the CRICOS course code (see http://cricos.education.gov.au/course/coursesearch.aspx ).

Preference 1 Course Title

Institution

CRICOS code

Preference 2 Course Title

Institution

CRICOS Code

Have you made an application to an Australian University in the last two years?

Yes

No – This will not disqualify you.

If YES, please attach details, such as a copy of the acceptance letter or other correspondence from the University, to your application.

Why have you chosen this study program?



Research Program Applicants (only) If you intend to apply for a research-based Masters or PhD program that will include at least 50 percent research, you must provide an outline of the proposed research project. If your proposed study does not include a research component, go to Part 4 of this application.

Research Title (max 250 characters, approx. 30-50 words limit)

Objective (max 1000 characters, approx. 150-200 words limit)

Significance and possible application of your proposed research to PNG’s development (max 1000 characters, approx. 150-200 words limit)



Research Methodology (max 1000 characters, approx. 150-200 words limit)

Research Supervisor Details Proposed Research Supervisor in Australia

Position:

Institution / Organisation:

Contact Phone Number

Email

Summarise any discussions or communication you have had with your proposed supervisor in formulating your research plan.



Research Fieldwork Details Does your research include fieldwork?

Yes

No

If YES, describe the fieldwork you will be undertaking (max 1000 characters, approx. 200 words limit)

What is the duration of your proposed fieldwork? (in weeks)

weeks

In which country will you undertake the proposed fieldwork?

Proposed Fieldwork Supervisor

Position:

Institution / Organisation:


Email



PART 4: Curriculum Vitae

Full Name

Address

Email Phone:

Date of Birth Current Age:

Study History Enter the highest course of study you have completed here.

Qualification Name

Level of Study Secondary (High School)

Diploma / Vocational/Technical

Undergraduate

Postgraduate

Name of Institution

State / Province

Country

Language of Instruction

Start Date End Date

Final GPA for the course/degree as shown on the Transcript of Results or as Certified by the University or Institution (if no GPA calculated for this course, leave blank):

Other Studies

Enter details of earlier completed studies, or any incomplete studies, from most recent to earliest.

Qualification Name



Undergraduate

Postgraduate

Name of Institution

State / Province

Country


Start Date End Date

Status Complete Pending results Incomplete Withdrawn



Qualification Name



Undergraduate

Postgraduate

Name of Institution

State / Province

Country


Start Date End Date


Qualification Name



Undergraduate

Postgraduate

Name of Institution

State / Province

Country


Start Date End Date


If you have received any academic awards or prizes, please provide details:



Employment History Please start with your current (or most recent) position and work backwards.

Position Title

Employing Organisation

Location

Country

Start Date End Date

Duties and Achievements (Max 100 words)

Position Title


Location

Country

Start Date End Date




Position Title


Location

Country

Start Date End Date


Position Title v


Location

Country

Start Date End Date


Please summarize any earlier employment history here (year, position, employment organisation)



Academic and Professional Referees Referee # 1: Given Name

Surname

Position

Organisation


Email

Referee #2: Given Name

Surname

Position

Organisation


Email



PART 5: Commitment and Support

COMPLETE, PRINT, SIGN AND SCAN THIS PAGE

Current Employer’s Statement Employer

All applicants must include a statement of support from an authorized officer from their employing agency, using this form. If you are self-employed, have a pastor or community leader complete this section. This section of the application is for the employer to explain the benefits expected from the Award. Employers must also sign the declaration and endorsement section in Part 5 of this form.

Please explain your work relationship with the applicant (i.e. are you the immediate supervisor) and indicate the length of time you have known the applicant on a professional basis.

As the applicant’s current employer, do you expect that the applicant will return to employment with your organisation on their return to PNG if they are awarded a scholarship?

Yes No

What skills gap or human resource need identified in your organisation, department or community would you like the nominee to address with this scholarship? Include an excerpt from your Strategic Plan or HR Work/Training Plan, organisational documents or needs analysis if possible.

Describe the policy, process or activity that your applicant’s reintegration plan will improve when they return. Be as specific as possible.

What problem needs to be addressed?:

Employer’s Initials:




What will the plan do?:

If the plan is successful, what change will occur?

How does this Reintegration plan connect to your organisational/departmental objectives or mission? Include an excerpt from organisational documents if possible (eg. Strategic plan, mission statement).

Which of PNG’s development priorities does the applicant’s Reintegration Plan contribute to? Reference Vision 2050 or other development documents.

Employer’s Initials:




How would you rate the leadership ability or potential of the applicant.

Excellent Very Good Average Poor Very Poor

Rate the benefit for your organisation from an Award to the applicant.


Please rate the suitability of the applicant for an Award having regard to their punctuality, diligence, reliability, integrity and aptitude.


Is your organisation prepared to offer support to the applicant while they are on Award in Australia?

Yes No

If YES, please outline what support is planned.

Current Employer’s Endorsement and Signature This section must be signed by an authorised officer of the employment organisation, who must also initial the printed, scanned copy of the preceding pages. If you are self-employed it must be signed by your pastor or a senior community leader

Do you support the candidate in their application for this award? Yes No

Are you the person who completed the Employer Statement in this application? Yes No

Employer Name:

Position:

Contact Details:

Employer Signature (and stamp if available)

Date




Applicant’s Declaration and Signature Authorisation DFAT must comply with the Privacy Act 1988 in relation to the personal information you have provided in this form.

By submitting this form I authorise DFAT, or its appointed managing contractor, to access and/or obtain information, including copies of any of my relevant academic records/reports from the education institution(s) that I have attended for the following purposes: for use in the selection process for an Australia Award to monitor my academic performance at my host institution while studying under an Australia Award to brief relevant Australian officials, Ministers and members of Parliament.

I also consent: a) to the Australian Government using and disclosing extracts of my application (relating to my academic

background and achievements, leadership skills and my proposed study program in Australia) in promotional material in hardcopy and on the Internet. I note that promotional material may include, but is not limited to, media releases and information circulated to DFAT’s offshore Posts and Australian education institutions, concerning the Australia Awards.

b) to my personal information and that of my family members and dependants, including sensitive information as defined in the Privacy Act 1988, being collected, handled, used and disclosed by and exchanged between DFAT, other government agencies including Australian immigration authorities, Australian education institutions, partner organisations (including managing contractors and sub-contractors), medical insurers, medical practitioners, case managers, my home government and other parties, in the circumstances outlined, and for the purposes indicated, in the Australia Awards Scholarships Policy Handbook as updated from time to time.

I authorise DFAT to disclose the personal information collected in this form to other Australian Government departments and Australian education institutions for the purpose of promoting and managing the Australia Awards.

Understanding

I understand and confirm that: I have read and complied with the Australia Awards Scholarships Policy Handbook and that the contents of my

application are true and correct DFAT has the right to vary or reverse any decision regarding a scholarship made on the basis of incorrect or

incomplete information Decisions of the selection panel are final and confidential and no correspondence about outcomes of the

selection process will be entered into.

Agreement

If successful in gaining an Australia Award, I agree that I will: undergo a police or character check before my Australia Award is confirmed immediately provide DFAT through the Australia Awards - PNG Facility with details of any incident that may

reflect badly on the prestige of an Australia Award act in a manner befitting a recipient of an Australia Award use the funds for the purposes granted 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 it 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

Signature Date



Feedback Information How did you first find out about Australia Awards – PNG Facility and the Australia Awards Scholarships?

Scholarship recipient

Friend, relative or colleague

Alumni Association

Australian Embassy or Australian Education Centre ( specify location below)

Australia Awards – PNG Facility Information Centre

Australia Awards Scholarships information session

Australia Awards Pacific Scholarships information session

Australia Awards – PNG Professional Development Initiatives / Small Grants information session

Australia Awards - PNG Facility Website

DFAT Website

Australia Awards Website

TV or Radio program or advertisement (please specify)

Publication (please specify)

Workplace or nominating authority

Home institution or university (please specify)

Australian institution or university (please specify)

Other (please specify)

Please Specify here:



Submit Your Application

Submission Checklist Please note that any applications that do not attach the required supporting documents, or that do not meet all the submission requirements listed below will be treated as non-compliant and may be disqualified.

Note: The interactive features of this page may not function in all PDF Reader software. For further information, please email the Australia Awards – PNG Facility at [email protected]

Step 1: Submission Requirements

All relevant fields in this Application Form completed.

Questions must be answered in the spaces provided in the Application Form. Answers provided on separate sheets or in any other format will not be accepted.

Click to check for completeness

Current Employer’s Statement completed and signed by your Employer.

Click to check for completeness

Click to print Employer’s Statement

Signed and scanned?

Applicant’s Declaration and Signature page completed and signed by you.

Click to print Declaration and Endorsements

Signed and scanned?

Step 2: Supporting Documents

Please tick each item that is attached to your application.

Proof Of Identity Birth Certificate. Attach a copy of your birth certificate if available. You will be required to bring the original document if selected for interview.

Evidence of change of name.Attach if required

Passport. Copy of data page, including photo, must be provided if available.

Proposed Study

Letter of Offer or other correspondence with an Australian University. Optional.

Letter from Supervisor supporting proposed research plan. Optional.



Academic Certificates and Transcripts When applying, include scanned copies of the relevant certificates and transcripts with your application. You will be required to bring the originals or certified copies with you if selected for interview.

Bachelor’s Degree Certificate(s). Mandatory for Masters degree applicants .

Bachelor’s Degree Transcript(s) of Results. Mandatory for Masters degree applicants.

Postgraduate Certificate(s). For studies undertaken since finishing your Bachelor’s degree. Mandatory for PhD applicants.

Postgraduate Transcript(s) of Results. For studies undertaken since finishing your Bachelor’s degree. Mandatory for PhD applicants.

Year 12 Certificate. Mandatory for undergraduate or diploma applicants. Not required for Masters or PhD applicants.

Year 12 Transcript of Results. Mandatory for undergraduate or diploma applicants. Not required for Masters or PhD applicants.

English Language Proficiency IELTS, TOEFL or PTE test results. Provide if available. If selected for interview, bring the original or certified copy with you.

Performance Reports from your current employer. Optional.

Step 3: Submit this Application Form

If you are using a desktop email system, you may use the Send button below to create an email message to Australia Awards - PNG Facility with your application form already attached.

Alternatively, you can

save the form,

manually create an an email message in your desktop email or web-based email system,

attach the saved form, and

send to [email protected]

Click to send your application

Note that all applicants are strongly encouraged to submit their application and all required supporting documentation via email to [email protected] using the correct e-form. You can obtain the correct e-form by sending a request via the Australia Awards – PNG Facility website, www.australiaawardspng.org



If you are unable to obtain the e-form or submit your application and all required supporting documentation by email, you may complete the attached “hard copy” form and submit your application as a hard copy. Note that this form and all supporting documentation must be sent to the Australia Awards – PNG Facility office in Port Moresby at the address shown below. Do not submit your application to any other address, agency or organisation.

Postal Address:

Australia Awards – PNG Facility Private Mail Bag Port Moresby Post Office Port Moresby Papua New Guinea

Courier Address:

Australia Awards – PNG Facility Ground Floor Port Towers Hunter Street Port Moresby Papua New Guinea

If you are sending your application by courier, you must use the courier address. Courier companies cannot deliver to a Private Bag or PO Box address and should not accept your order if you specify one.

If you have completed this hardcopy application, you should not submit an electronic copy of this form. However if at all possible we encourage you to submit an electronic application rather than a hard copy to reduce the risk of loss or delay in transit.

Submission Notification: Once you have submitted your hardcopy application, please email the following details to [email protected] as proof of submission of your application: full name; country of residence; contact phone number; date of submission of application; agency to whom application was submitted, courier name and tracking number if applicable. Send this message using the contact email account you have specified in the application form. Subject line should read: SUBMISSION NOTIFICATION.

Submitting your application by email If you wish to submit your application by email, please use the electronic application form. However, if you are not able to courier the hardcopy application, and you cannot obtain or complete the e-application, you may submit a scanned hardcopy application by carefully following these instructions:

Email the scanned copy to [email protected]. Subject must be HARDCOPY APPLICATION. All pages of the application must be attached to one email message, preferably as a single PDF file. Send your supporting documents to the same email address using a separate email message for each. The subject line should include your name and the document title; e.g. Jane Doe: Academic Transcript. Important: All emails must be sent using the email account you have specified on this application form. Files sent from any other email account will not be included in your application.

Submitting your application by soft copy (Flash drive-USB) Provincial Candidates also have the option to submit your application by soft copy (flash drive-USB).

To submit by soft copy please complete your application form using the correct Adobe Reader XI.

Save your completed e-application and all your supporting documents into a folder on your Flash drive titled using your name as follows: AAS2017_SURNAME_FirstName.

Example: AAS2017_CITIZEN_John

Please ensure that there are No other files on the Flash drive other than the application form and any supporting documents as requested in the application process.

All documents should be saved as single PDF files.



The flash drive containing your application and supporting documents must be sent to the Australia Awards – PNG Facility office in Port Moresby at the address shown above. Do not send your flash drive to any other address, agency or organisation.

If you are sending by courier please ensure you send to the courier address as courier companies cannot deliver to Private Mail bags or PO Box addresses and should not accept your order if you incorrectly specify one.

Please note: the Australia Awards – PNG Facility will not be held responsible for Flash drive-USB’s that contain Malware or Viruses that may prevent the application form being uploaded by the Australia Awards – PNG Facility.