![Page 1: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/1.jpg)
The University of MelbourneMCKENZIE POST-DOCTORAL FELLOWSHIPS PROGRAM
Application Form for 2016 Commencement
Please refer to the Funding Guidelines before completing this form.
Submission:
Applications close Friday 25 September 2015 Combine the Application Form, Application Checklist and any supporting material
including all declarations (excluding Referee Testimonials) into one pdf file Name the pdf file ‘McKenzie_2016_SURNAME OF APPLICANT’ By the closing date, send application via email to [email protected]
with the subject heading ‘McKenzie 2016 – Application – SURNAME OF APPLICANT’
Formatting:
All text within an application must meet the following formatting requirements: Typewritten in black type Single column Minimum 12 point highly legible font (e.g. Helvetica, Times New Roman and Arial). This
includes reference lists, figure captions, table captions and table contents. Text within figures may be any font size, but should be legible for reviewers
Must not include URLs except in reference lists (do not hyperlink URLs in reference lists); Colour may be used in figures, but any labelling must be in black type
PART A - Administrative Summary
A1 Applicant Information
Title Surname
Given Name(s)
Address
Nationality
Telephone
Email Address
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 1
![Page 2: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/2.jpg)
A2 Host Department(s) Information
School, Department or Centre in which you wish to work
Faculty/Graduate School
Proposed Commencement Date
Full Name of University of Melbourne (UoM) academic contact
Email address of UoM academic contact
PART B – Eligibility
B1 Have you obtained an Eligibility Exemption Approval from Research, Innovation and Commercialisation?
If ‘yes’, please attach a copy of the email notification to this Application Form
YES/NO/NA
B2 Have you experienced a Career Interruption, e.g. chronic illness, child bearing, child rearing or other family responsibilities such as primary responsibility for the sustained care of a dependent family member (who may, for example, be elderly, sick or a person with disabilities) that does not require Eligibility Exemption?
If ‘yes’, please complete Part E of this Application Form
YES/NO/NA
PART C – Citizenship / Residency Status
International Applicants – please note that it is the responsibility of successful Fellows to obtain an appropriate entry visa to Australia. This Scheme does not provide funding for visa expenses.
Are you an Australian Citizen?
If you are not an Australian Citizen, do you hold Permanent Residency Status?
Are you an Aboriginal and/or Torres Strait Islander?Answer is optional
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 2
![Page 3: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/3.jpg)
PART D – Academic Record
Please list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award1 of your PhD to the application form.
Name of institution Name of degree/diploma(show level of honours where applicable)
Completion date(month and year)
(Add or delete rows in the table above as required)
PART E – Career Interruption
Only to be completed if you indicated YES in Part B2
This section is only applicable for applicants who have been awarded their PhD on or after 1 January 2011 and had a period of significant research career interruption between 1 January 2013 and 25 September 2015.
Applicants should be able to clearly demonstrate that their research career has been significantly constrained or interrupted by circumstances such as chronic illness, child bearing, child rearing or other family responsibilities such as primary responsibility for the sustained care of a dependent family member (who may, for example, be elderly, sick or a person with disabilities).
If you do not fit the requirements above, and would still like to request exemption from one or more eligibility criteria, you must complete and submit Eligibility Exemption Request form.
Statement
Please outline the nature of the career interruption, demonstrating how your research career has been significantly constrained or interrupted. This statement should justify why your application should be considered under special circumstances. Maximum 700 words.
1 The date of the award is considered to be the date of the official notification letter. For those applicants attending institutions where no such letter is provided, equivalent evidence that they have graduated or have completed all the required steps to be eligible to graduate with a PhD must be provided to Research, Innovation and Commercialisation.
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 3
![Page 4: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/4.jpg)
PART F – Employment and Non-Employment Timeline
All applicants should indicate their employment (and non-employment, where applicable) history (in months/years and fraction Full Time Equivalent), in reverse chronological order since the date of PhD award. This should include any career interruptions for applicants who have completed Part E of this Application Form.
Time Period(Month/Year
– Month/Year)
Non-employment and employment history (include position title)
Was employment
research related
(Yes/No)
Total period(Months/Years)
Fraction Full Time
Equivalent
Documentation attached(Yes/No)
eg. Jan 11 - present
Teaching-only position, Level A No 8 months
0.5 Yes
eg. Jun 10 – Jan 11
Career interruption due to travel No 1 year 1.0 Yes
eg. Jan 09 – Jun 10 Researcher Yes 6 months 1.0 No
(Add or delete rows in the table above as required)
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 4
![Page 5: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/5.jpg)
PART G – Proposed Research Project
G1 Project Title
Maximum 200 characters.
G2 Aims and Approach
You must use the following headings and not exceed 700 words:
1. Aims and Significance
2. Relevance to the area in which it would be located
3. Expected Outcomes
4. Opportunities for further external funded fellowships or academic employment
5. References (only where required, and not exceeding one A4 page).
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 5
![Page 6: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/6.jpg)
G3 Significance and Alignment with Strategic Research Directions
Describe how the proposed project will contribute significantly to the advancement of knowledge in one or more areas of university/faculty research priority. Maximum 300 words.
G4 Collaboration
Describe what forms of collaboration within the university the applicant will be seeking to build if awarded the fellowship. Maximum 300 words.
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 6
![Page 7: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/7.jpg)
G5 Profile of Research Background
Provide a profile of your research activities, experience and strengths. Include information about your track record and the relationship of this proposal with work in the field generally. This is an opportunity to mention items that might not be mentioned in your CV. Maximum 300 words.
G6 The Fellowship in the Context of Career Plans
Provide a statement describing your career plan and how this Fellowship will benefit your career. Maximum 300 words.
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 7
![Page 8: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/8.jpg)
PART H – Referee Information
Please give the names and affiliations of your two (2) academic research referees.
Nominated Referee #1
Name
Position / Institution
Telephone Email
Nominated Referee #2
Name
Position / Institution
Telephone Email
Important Note: referees must provide written testimonials. Please supply referees with a copy of the Funding Guidelines and your application.
Please ensure that your Referees email their testimonials to [email protected] marked ‘McKenzie 2016 – Confidential Referee Report - SURNAME OF APPLICANT’ by Friday 25 September 2015.
PART I – Curriculum Vitae
GUIDELINES for CURRICULUM VITAE
The following headings are to be included in the accompanying curriculum vitae - maximum 3 pages in 12 point font (excluding publications).
1. Full name2. Address, telephone and email contact3. Nationality4. Full details of education, postgraduate training5. Details of awards or prizes6. Details of any postgraduate and undergraduate teaching and supervision7. Details of published works organised in the following categories:
Refereed journal articles (the date of acceptance should be provided for papers not yet published);
Reviews; Books; Chapters; Conference papers; Patents; Other publications.
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 8
![Page 9: PROJECT TITLE - Research · Web viewPlease list the course(s) that you are or have been enrolled in at a tertiary institution. If available, please attach evidence of the award The](https://reader036.vdocuments.us/reader036/viewer/2022072401/5e47f08fdea331129435e737/html5/thumbnails/9.jpg)
PART J – Declarations
Please note scanned electronic signatures are acceptable. You may also attach separate signature pages for Head of Department/School and Application Declarations.
Head of Department/School SupportI agree to support this application and to host the Fellowship, if successful.
Name
Department / School
Signature Date
Applicant DeclarationI declare that the information I have given in this application is true to the best of my belief and I understand that any offer of a Fellowship or employment as a Fellow may be withdrawn if false information is given.
Signature Date
PART K – Privacy
K. PRIVACY
The information requested is being collected for use by relevant Faculty Committee/s, made up of senior researchers in the host faculty, and the central University Selection Committee, an academic panel appointed by the Deputy Vice-Chancellor (Research). Copies of applications will be made available to the relevant Faculty and members of the central Committee. The names of the successful applicants and the ‘lay’ summary of their projects will be reported to relevant University committees and senior officers. Personal information will be held and used in accordance with the University’s Privacy Policy, available at http://www.unimelb.edu.au/unisec/privacy/index.html .
McKenzie Post-Doctoral Fellowships Program: Application Form for 2016 Commencement Page 9