project title - research · web viewplease list the course(s) that you are or have been enrolled in...

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

mailto:[email protected]

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


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.


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)


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).


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.


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.


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.




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 .


http://www.unimelb.edu.au/unisec/privacy/index.html

project title - research · web viewplease list the course(s) that you are or have been enrolled in...

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