Ad sapplicationform2012 beasiswa

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Ad sapplicationform2012 beasiswa

  1. 1. Australian Development Scholarships2013 Intake Application FormInstructionsPlease print neatly using block letters (huruf cetak) and black ink> Before completing this form, you must read the Australia Development Scholarships Handbook (The Handbook) and your Country’s profile, available on the AusAID Website (see below) or from the AusAID/Managing Contractor’s office in Indonesia. Brief information about the program is also included in this application form. Also see www.adsindonesia.or.id> You must complete all fields marked with an * and all relevant sections.> This application must be completed in English.> For “Yes” or “No” questions, indicate your response with an “X” in the appropriate box.> Three (3) copies of this form and of all attached documents must be received by 17 August 2012 at the Australia Awards Office at Gedung Wirausaha, 7th Floor. Jl. H.R. Rasuna Said Kav.C-5 Kuningan, Jakarta 12940.> DO NOT send this application to universities or other institutions in Australia.> Australian Development Scholarships will be offered only to those whose course of study will contribute to the long-term development needs of Indonesia. A list of the development priorities is available under “Choosing a Course of Study” on page 3 of this application form.> AusAID’s website includes a list of Australian Universities that may receive Development Scholarship awardees. Course of study information is available directly from the Universities’ websites or the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) website (see page 6 – Useful Websites).> You may provide two preferences for courses of study. You should consider two Australian universities rather than two courses at the same university, just in case you do not meet the admissibility requirements of the first Australian university.> If your application is successful, you will be required to sign a Contract with the Commonwealth of Australia and be bound by conditions of the scholarship. A full list of the conditions is contained in this application form (page 25 - 26) and in the Handbook. Please note that AusAID reserves the right to change these conditions at any time.> Submitting this application does not guarantee that you will receive a Scholarship.> If you do not receive an invitation to an interview from the Australia Awards Office by mid-December, you should assume that your application has been unsuccessful.> Before applying, all Public sector applicants are required to have section 23 of the form completed by the relevant training or foreign cooperation bureau or their university rector (whichever is applicable).> Applicants in the Open category are not required to fill in section 23. Their applications are to be submitted directly to the Australia Awards Office at the address above.> Applicants must not fill in section 25. This section is for use by the Ministry of State Secretariat of the Republic of Indonesia (SetNeg) and refers only to selected candidates.> In cases where information supplied by candidates is found to be inaccurate or incorrect, an award offer may be revoked without notice. The closing date is 17 August 2012 1
  2. 2. Applications should be submitted as early as possibleGeneral Information NotesAustralian Development Scholarships (ADS) provide opportunities for Indonesians to study in Australia atPOSTGRADUATE level.Up to four hundred and seventy five scholarships are expected to be awarded in 2013 for commencement in2013/2014 including twenty five Australian Leadership Award Scholarships (ALAS). Candidates must undertakestudy in one of the four areas of development priority (see page 3).ADS are offered in two main categories: ‘Public Sector Category’ and ‘Open Category’.Public sector applicants are employees from Government organizations, state universities and state ownedenterprises. Their applications must be approved by training or foreign cooperation bureaus (BKLN) of their local orcentral agencies before being submitted to the ADS Program Office. Public sector candidates from governmentagencies outside Jakarta may apply directly to the ADS Program Office with the approval of their relevant Kakanwil orKadinas and approval from Bupati or Governor (or representative) where necessary. Calon Pegawai Negeri Sipilare not eligible to apply.Open Category applicants are from private organisations and universities and this category is also open to recentuniversity graduates. No prior Government approval is required for people applying in the Open Category, andapplications are to be submitted directly to the Australia Awards Office. They require, where relevant, theendorsement of the agency, institution or private university in which the applicant is working or studying. Applicationsare submitted directly to the Australia Awards Office.Public servants (Pegawai Negeri) cannot apply in the Open category.A third category (Targeted) exists for candidates who are identified by their organisations in consultation with theADS Program. Candidates within this category must be identified by their home organization and must not apply tothe ADS Program independently of their employer.`Targeted Category candidates are employed by organisations which are identified by the Government of Indonesiaand Government of Australia (through AusAID) as being strategically aligned with the Development priorities of theGovernment of Indonesia.Scholarships are for full-time study for a Masters or Doctorate degree from Australian tertiary institutions. Thescholarship provides up to nine months full-time language and academic preparation in Indonesia. Students mustachieve satisfactory results in this training to be able to continue their scholarships.Applications from people with disabilities or from people in organisations working with the disabled areencouraged to apply.Women and candidates in provinces within the geographic focus of AusAIDs Country Strategy (see page 4) are alsoencouraged to apply.EligibilityIN GENERAL CANDIDATES MUST:> be an Indonesian citizen and not have permanent residence 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 resident status, at any stage of the application, selection, mobilisation processes or while on-scholarship in Australia> satisfy Australian Government requirements for international student entry to Australia (health, character etc)> not have obtained an academic qualification outside their home country in the 24 months preceding the application closing date, calculated from the date of arrival back in the home country> not be applying for another long-term AusAID scholarship unless they have returned to their home country and resided there for twice the length of the total time that they were in Australia (for example, a previous AusAID Scholar who has been on AusAID scholarship/s in Australia for five years will not be eligible to apply for another AusAID scholarship until they have been home for ten years)> be applying to commence a new course of study and not be seeking support through ADS for a course already commenced in Australia.> be able to take up the scholarship in the year for which it is offered> be able to satisfy all requirements of the Department of Immigration and Citizenship (DIAC) for an AusAID student visa and 2
  3. 3. > be able to satisfy the admission requirements of the Australian university at which the Scholarship is to be undertaken. 3
  4. 4. SPECIFICALLY, CANDIDATES MUST:> be applying for courses that fall within the areas of development priority (see “Choosing a Course of Study” below)> at the time of application, be not older than 42 years of age> have a Grade Point Average (GPA) of at least 2.9 on a scale of maximum 4.0 (or 2.75 for applicants from geographic focus of AusAID Country Strategy only, see page ii) and an English language proficiency of at least 5.0 in IELTS (or 500 in paper-based TOEFL or 61 in Internet based TOEFL). The IELTS or TOEFL result must be current (a test result obtained in 2011 or 2012 will be considered current). No other English language test (including TOEFL prediction test) results will be accepted. Contact details of test centre must be provided for verification of TOEFL test results.> have a Grade Point Average (GPA) of at least 2.75 for awardees with a disability as declared on the ADS application form.> already hold an undergraduate degree, if applying for a Masters> already have a Masters, if applying for a Doctorate> apply for a degree at a level higher than their current highest qualification> if applying for a Doctorate, applicants will be restricted to staff of universities, higher education institutions, research institutes, key policy makers and targeted candidates in other agencies associated with AusAID activities> it is highly desirable for Doctorate applicants to have a letter of support from an Australian university for their proposed field of study> answer all relevant questions on the application form> be willing and available to undertake full-time (Monday - Friday 0800-1600) English for Academic Purposes (EAP) training in Indonesia prior to studying in Australia, if offered a scholarship.Choosing a Course of Study Candidates are encouraged to apply to study courses which fall within AusAIDs priority development areas (PDA). The PDA relate directly to the strategic objectives contained in the Australia and Indonesia Country Strategy. An indicative list of the areas for study follows.AustraliaIndonesiaPartnership Sustainable Growth and Democracy Justice and Investing in People Safety and PeacePriority Economic Management Good GovernanceDevelopmentAreas (PDA)Description of Improving economic policy Strengthening the Better quality, access Improving responses toPDA and management, reducing capacity, accountability and governance in humanitarian needs, constraints to growth in and responsiveness of education, and better emergencies and infrastructure and legal, democratic and health access and vulnerability to productivity, and improving oversight institutions, and systems disasters, and natural resource improving local improving capacity to management, environmental government and public ensure transport governance and response to financial management. security and to counter climate change. threats from transnational crime.Australia • Natural Resource • Law, legal and • Communicable • Conflict ResolutionIndonesia Management judicial systems Disease Prevention • DisasterPartnership • Agriculture • Political Science and • Health Prevention andPriority Fields • Aquaculture/fisheries Government Management Managementof Study • Public administration • Health Services • Transport Safety • Forestry • Climate Change • Public expenditure management • Maternal and Child Health • Transnational • Economics Crime Prevention • Infrastructure Planning • Public Sector • Women and • Development • Water and Sanitation Reform Gender Studies Studies • Rural Growth • Environmental Law • Disability Services • International • Small and medium • Anti-corruption • Public Health Studies enterprise development • Decentralisation • Education and • Monitoring & Training Evaluation • Education Management • Human Resource 4
  5. 5. Development • Childhood Special Education NB: If your study area is not listed here, you may still apply for a field of study related to the work of AusAID in Indonesia. For more information see the Australia Indonesia Partnership Country Strategy at: http://www.indo.ausaid.gov.au/docs/aipstrategyinfo.html Candidates considering study for particular professions should note that ADS does not include the practical training period required for professional registration, e.g. medical internships, legal articles etc. Successful awardees are expected to complete such training in their own country.Selection Process All applicants are considered by an independent Joint Selection Committee comprised of Australian and Indonesian academics. Only those shortlisted will be interviewed. The interview will assess candidates academic ability, clarity of study goals, cultural adaptability. A critical consideration will be how well the ADS applicant is able to explain the relevance of their proposed study area to the development of Indonesia. The interview will be accompanied by an IELTS test of English language proficiency. Final selection is objective and based on the principles of merit and equity. The final list of awardees is subject to scrutiny and endorsement by AusAID and Government of Indonesia - State Secretariat. SELECTION QUOTAS: In the 2012/2013 ADS cycle, up to four hundred and seventy five (475) ADS scholarships are available for commencement in 2013/2014 including twenty five (25) Australian Leadership Award Scholarships (ALAS). The scholarships are allocated as follows:> 2/3 of all awards will be offered in the `Public Sector category> 1/3 of all awards will be offered in the `Open category> up to 50 percent of awards will be offered in the Targeted Sector Category> up to 30 percent of all scholarships will be awarded in line with geographic focus of the Country Program Strategy. (The geographic focus will include East Nusa Tenggara, West Nusa Tenggara, Papua, West Papua, and Aceh)> 85 percent of awards at Masters level and up to 15 percent at Doctorate (PhD) level. (NB doctoral level study is only open to staff of universities, higher education institutions, research institute, key policy makers and targeted candidates in other organizations associated with AusAID activities.> an equal number of awards will be offered to men and women. NOTIFICATION OF THE SELECTION RESULT All applicants will be advised whether or not they have been selected for an interview. All interviewed applicants will be notified whether or not they have been awarded an ADS. The result is final and no correspondence will be entered into. Where appropriate, notification will include details of pre-departure training (English, academic skills, cultural preparation). This training is compulsory and full-time (see page 7 for step by step of ADS Application Process).Requirements for Scholarship Recipients Prior to travelling to Australia, scholarship recipients must:> meet the minimum English language requirement of their chosen Australian university (usually IELTS of 6.5 with no band less than 6.0)> at the completion of EAP training, candidates must achieve a minimum score of IELTS 6.0 for ADS office to commence the application process for placement in a university program in Australia> receive a letter of acceptance from an Australian university> meet Australian immigration requirements for a student visa> receive Government of Indonesia endorsement 5
  6. 6. > be medically fit to commence studies in Australia. 6
  7. 7. In Australia, scholarship recipients must:> abide by the conditions of the scholarship and the rules of Australian tertiary institutions> abide by the rules and regulations governing a student visa> act in a way that will not bring disrepute to AusAID, or to any Australian university or to Indonesia> return to Indonesia for a period of two years at the completion of their study/research program in Australia. If during the two years exclusion period the scholarship recipients return to Australia, a debt to the Commonwealth may be activated OR any time spent in Australia may be added to the two year exclusion period. Calculation of the two years exclusion period starts when the scholarships recipients arrive Indonesia, not the visa expire date. What do Australian Development Scholarships cover?> Pre-Course English – provision of English for Academic Purposes training prior to commencement of studies in Australia (including an in-Indonesia stipend)> In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee mobilisation. This does not apply to any deferral period.> Medical examination and x-ray costs in order to comply with Student Visa requirements> AusAID Student Visa and Student Dependant Visa> Outward Airfare (economy- one way) from the airport closest to the awardee’s home location to the international airport closest to the Australian university selected for study by the awardee> Overseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for any accompanying family in order to satisfy visa requirements).> Establishment Allowance payable into the awardee’s bank account after arrival in Australia> Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to living expenses (CLE).> Introductory Academic Program (IAP) for a period of 4-6 weeks undertaken prior to the commencement of Masters or PhD studies> Masters OR PhD Tuition Fees – including all compulsory fees for the course in which the awardee is accepted into> Supplementary Academic Support - provided where it is deemed essential to assist awardees to pass course subjects.> Fieldwork - holders of a scholarship where research comprises at least 50 percent of the program may receive a return economy class airfare to Indonesia to undertake essential fieldwork.> Reunion Airfare - is available to a ‘single’ awardee after the successful completion of the first year of study; subsequent reunion airfare entitlements will be available on an annual basis for the duration of the ADS, except for the final year of the ADS.> Homeward Airfare (economy- one way) from the international airport closest to the Australian university selected for study by the awardee to the airport closest to the awardee’s home location.. Family Entry Awardees can bring their immediate families to Australia at their own cost, if their families meet AusAID and immigration requirements. Families are normally permitted to join eight (8) weeks after the awardees arrival. 7
  8. 8. Useful websites Australia Awards: http://australiaawards.gov.au/ Australia Awards – Development Scholarships: http://www.ausaid.gov.au/scholar Australian Development Scholarship (ADS) Indonesia: http://www.australiaawardsindo.or.id Visas – Department of Immigration and Citizenship: http://www.immi.gov.au Studying in Australia: http://www.studyinaustralia.gov.auAustralian Educational Institutions and courses - the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS): http://cricos.deewr.gov.au IELTS: http://www.ielts.org.au TOEFL: http://www.ets.org/toefl The ADS Application Process Step 1 Applicant sends complete ADS application form to Australia Awards Office by 17 August 2012. Step 2 Applicant is notified of the result of selection for interview by December 2012. Step 3 Applicant selected for interview receives information of interview/ IELTS test date/location. Step 4 Applicant attends interview and IELTS test in January 2013. Step 5 Applicant is advised of the result of their ADS application by February 2013. 8
  9. 9. Australian Development Scholarships2013 Intake Application Form 1. Personal detailsProvide supporting documentary evidence of your full name, date of birth, gender and country ofcitizenship. For example, the identification page of your passport or other official identification Attach a recentdocument issued by your country of citizenship. passport size photo. 3 x 4 cm.* Denotes mandatory fieldTitle* Mr Mrs Ms Miss Dr Other(Please specify)      Given name* Enter your family name and other names as       shown in your Birth Certificate, Passport or other official identification document. If youFamily names*       have only one name, enter it in both fields.Date of birth*   /   /      dd/mm/yyyy Gender* Male FemalePlace of birth* (State/province)      Which country are you living in now?*      Have you applied, or are you intending to apply, for permanent residency or Yes Nocitizenship in Australia or New Zealand?*National Identity Number      (KTP No.)Passport no. Issue date   /   /     (provide if you have a      passport).* Expiry date   /   /      9
  10. 10. 2. Contact detailsResidential address (Please check that your contact details are correct. The scholarship application takes several months to be finalised. If youcannot be contacted, your application will not proceed.)Address line 1*      Address line 2      Address line 3      Town/City*      State/Province*       Postal code (if any)      Country*      Mailing address (Provide details only if this is different to your current residential address.)Address line 1      Address line 2      Address line 3      Town/City      State/Province       Postal code (if any)      Country      Phone and email (Provide at least one contact number.)Home phone no.*       Work phone no.      Mobile no.       Fax no. (if any)      Email 1      Email 2      Current Work address (Please provide your current work address where you can also be contacted. If you cannot be contacted, your applicationwill not proceed.)Address line 1*      Address line 2      Address line 3      Town/City*      State/Province*       Postal code (if any)      Country*       10
  11. 11. 3. Spouse details*If you have dependants (spouse and/or children under 18 years of age), provide their details even if they will notaccompany you to Australia. Note that the scholarship does not provide financial support for accompanying dependants.You can get information on your responsibilities for your spouse and any dependant children, should they live with you inAustralia during your scholarship, from the Department of Immigration and Citizenship (DIAC) or by contacting theuniversity where you want to study.Given name*       Provide family name and other names as shown in your spouse’s birth certificate, passport or other official identification document*Family names*      Date of birth*   /   /      dd/mm/yyyy Gender* Male FemalePassport no. Issue date   /   /     Provide if spouse      has a passport.* Expiry Date   /   /     Country of      citizenshipWill your spouse accompany you to Australia?* Yes No4. Children details (attach a separate list if there is not enough space)Provide details of any dependent children and indicate if they will join you in Australia.A dependent child is the child or stepchild, of yourself or your spouse, who is not married or engaged to be married andhas not turned 18 years of age.NB: This Scholarship does not provide financial support for family members accompanying you to Australia.Information on your responsibilities for any children that will live with you in Australia during your scholarship can beobtained from the Australian Government Department of Immigration and Citizenship website or by contacting theuniversity where you want to study.Child 1 Will this child accompany you to Australia?* Yes NoFamily name      Given names      Date of birth   /   /      dd/mm/yyyy Gender Male FemaleCountry of citizenship      Passport no. Issue date   /   /     Provide if child has a       Expiry date   /   /     passport.*Child 2 Will this child accompany you to Australia?* Yes NoFamily name      Given names      Date of birth   /   /      dd/mm/yyyy Gender Male FemaleCountry of citizenship      Passport no. Issue date   /   /     Provide if child has a       Expiry date   /   /     passport.* 11
  12. 12. Children details continuedChild 3 Will this child accompany you to Australia?* Yes NoFamily name      Given names      Date of birth   /   /      dd/mm/yyyy Gender Male FemaleCountry of citizenship      Passport no. Issue date   /   /     Provide if child has a       Expiry date   /   /     passport.*5. Emergency contact details*Provide details of a person that can be contacted in case of an emergency. This may be a relative or a friend. Mr Mrs Ms Miss DrTitle* Other Please specify       Relationship toFamily name*             you*Given name*       Gender* Male FemaleHome phone*       Work phone      Mobile phone       Fax (if any)      Email 1      Email 2      Address line 1*      Address line 2      Address line 3      Town/City*      State/Province*       Postal code (if any)      Country* Please check that the contact details are correct       6. Previous scholarships (attach a separate list if there is not enough space)Only include details of post-secondary school scholarships or fellowships.Have you previously been awarded a scholarship or a fellowship?* Yes No1. Scholarship/fellowship title      Start date       End date       Country      Qualification (if applicable)      University       12
  13. 13. Previous scholarships continued2. Scholarship/fellowship title      Start date       End date      Qualification (if applicable)      University       7. Scholarship applicationsHave you previously applied for an AusAID scholarship but were Yes Nounsuccessful?*If "Yes" how many times have you previously applied for ADS?      Have you previously been interviewed by ADS?* Yes NoIf ‘Yes’, in which years?       8. DisabilityAusAID strongly encourages applications from people with disability who are otherwise eligible for a Scholarship. Under the DisabilityDiscrimination 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 adisability/special need must provide details of the disability and/or special need when they accept their offer. This information is bound byAustralian 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 beavailable depending on the relevant Institutions capacity. AusAID will advise the Institution of any special requirements associated with anAwardee 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 or do you work in a disability-focused organisation?*neurological, learning disabilities, physical disfigurement, and the presence in the body of Yes Nodisease-causing organisms(http://www.hreoc.gov.au/disability_rights/dda_guide/who/who.html)If yes, please provide details if you require special assistance or equipment to participate in the Scholarship selectionprocesses or to live and undertake studies in Australia?      9. Under Which Category are you applying for an ADS? * Open PublicIf “Open”, please indicate if your application is from: If “Public”, please indicate if your application is from: Private university Government Department Private individual State-owned Enterprise State University10. Proposed study program* 13
  14. 14. AusAID will consider offering you a scholarship only if your course of study will contribute to the long-term developmentneeds of your country. Note that the proposed program of study should be appropriate to your academic qualification andwork experience.Requested Level of study* Type of study* (Masters Masters Coursework(You will not be allowed to coursework program can contain aupgrade your course from the research project up to 30% of the Researchlevel at which you are first Doctorate (PhD) Masters. Candidate decide the topicplaced). during course) CombinationResearch background of Doctorate(PhD) candidates only:*  Do you hold a Masters degree with > 50% weighting for research? Yes No  Are you including a letter from your Masters supervisor recommending that you should pursue Doctorate studies? (Recommended) Yes NoProposed field of study*You are required to:  Identify the priority Development Area (PDA) for your proposed studies. (Please tick one box only).  Identify the Priority Field of Study (PFS) from the list of preferred PFS provided (Please tick one box only).  If necessary, you may nominate another Field of Study in other (Please tick other and provide detail).AustraliaIndonesia Sustainable Growth Democracy Justice Investing in People Safety and PeacePartnership and Economic and GoodPriority Management GovernanceDevelopmentAreas (PDA)*Description Improving economic Strengthening the Better quality, access and Improving responses toof PDA policy and management, capacity, accountability governance in education, humanitarian needs, reducing constraints to and responsiveness of and better health access emergencies and vulnerability growth in infrastructure legal, democratic and and systems to disasters, and improving and productivity, and oversight institutions, and capacity to ensure transport improving natural improving local security and to counter resource management, government and public threats from transnational environmental financial management. crime. governance and response to climate change.Australia Natural Resource Law, legal and judicial Communicable Conflict ResolutionIndonesia Management systems Disease Prevention Disaster Prevention andPartnership Agriculture Political Science and Health Management ManagementPriority Aquaculture/fisheries Government Health Services Transport SafetyFields of Public administration Forestry Maternal and Child Transnational CrimeStudy (PFS)* Climate Change Public expenditure Health Prevention management Women and Gender Development Studies Economics Public Sector Reform Studies International Studies Infrastructure Environmental Law Disability Services Planning Anti-corruption Public Health Water and Sanitation Decentralisation Education and Rural Growth Monitoring & Training Small and medium Evaluation Education enterprise Management development Human Resource Development Childhood Special Education Other, please specify:       14
  15. 15. Proposed study program* continuedHave you obtained information from the ADS Information CD, or from the ADS Yes Nowebsite regarding study options in Australia?Please describe the efforts you have undertaken so far to obtain information on your study options in Australia.      ADS - Australian Universities ListFollowing Australian universities are under contract to AusAID to provide courses for ADS awardees. Awardees arerequired to find a suitable course of study at one of these Australian universities. PhD candidates must find a supervisor atone of these universities. Please visit the following website for more details on Australian Educational Institutions andcourses - CRICOS: http://cricos.deewr.gov.au• Australian Maritime College • Murdoch University • University of Canberra • Queensland University of Technology • University of Newcastle• Australian Catholic University • RMIT University • University of New England• Carnegie Mellon University • Southern Cross University • University of New South Wales• Central Queensland University • Swinburne University of Technology • University of South Australia • The Australian National University • University of Southern Queensland• Charles Darwin University • The Flinders University of South Australia • University of Tasmania• Charles Sturt University • The University of Adelaide • University of Technology, Sydney • The University of Melbourne • University of the Sunshine Coast• Curtin University of Technology • The University of Queensland • University of Western Sydney• Deakin University • The University of Sydney • University of Wollongong• Edith Cowan University • The University of Western Australia • Victoria University• Griffith University • UCL School of Energy and Resources • Bond University• James Cook University • University of Ballarat • The University of Notre Dame Australia• La Trobe University• Macquarie University• Monash UniversityProposed preferencesIf you are selected for the scholarship the Australia Awards Office will forward your application to your prefer Australianuniversity and course of study. You need to decide which Australian university you want to attend and choose anappropriate course. You should choose two courses of study. You are encouraged to choose two different Australianuniversities rather than two different courses at the same university. If your application for the first choice of study isunsuccessful, AusAID will forward your application to your second choice. The CRICOS code from your course can befound on the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) Websitehttp://cricos.deewr.gov.auTo find out about the content of specific courses, you should refer to the individual Australian university websites. Thisinformation can also be found on the ADS Information CD which can be obtained from the Australia Awards Office or ADSwebsite http://www.adsindonesia.or.id.Preference 1*Course title or particular focus      area within your identifiedproposed Field of Study.*CRICOS code (if applicable)*       Australian University       (if applicable) Minimum EnglishCourse duration (weeks) language proficiency            (if applicable) required for the course (IELTS) (if applicable) 15
  16. 16. Proposed preferences continuedPreference 2*Course title or particular focus      area within your identifiedproposed Field of Study.*CRICOS code (if applicable)*       Australian University       (if applicable) Minimum EnglishCourse duration (weeks) language proficiency            (if applicable) required for the course (IELTS) (if applicable)A formal offer of admission will not be required however it is expected seriousPhD candidates will have made preliminary enquiries to possible Australianuniversities regarding their study. Yes NoHave you discussed your proposed course with a member of staff from anyAustralian university? This is highly recommended for PhD applicants. If “Yes”,please attach any relevant correspondence with Australian universities.Are there any special subjects or skills development that you would like to include Yes Noin your choice?If "Yes" please give details. (Note that ADS does not include the practical training period required for professionalregistration, e.g. medical internship, legal articles etc. Applicants are expected to complete such practical training in theirown country).      16
  17. 17. Research proposal detailsComplete this section if the studies will be by Research or a combination of Research and Coursework. E.g. Doctorateor Masters by Research. Otherwise proceed to next question. Answers should be concise but sufficient to explain thenature of your research proposal to the selection panel. Please note word limits. Anything over this limit will not beconsidered.Research title      (max 250 characters,approx 30-50 words limit)What is the background to      the research beingproposed? (maximum 150words / + 1,000characters)Provide a Research      Statement (purpose ofstudy) to accompany theproposed research. Thiscan include a statement onwhat is special and uniqueabout the research?)(maximum 100 words / +700 characters)What hypothesis are you      testing in your proposedresearch? (maximum 50words / + 350 characters)What are the objectives of      the proposed research?(maximum 200 words / +1,300 characters) 17
  18. 18. Research proposal detailsWhat is the      methodology/structure inyour proposed research?(include comments onmeasurements, datasources, methods ofanalysis and timelines)(maximum 200 words / +1,300 characters)Have you published any      research to date? (includetexts, journal articles –providing full citation)Which university do you      consider appropriate foryour proposed studies?Why? (maximum 50 words/ + 350 characters)Have you considered a      possible researchsupervisor? Why thisselection?(maximum 50words / + 350 characters)What is the relevance of      the proposed research toIndonesia?Does your proposed research include fieldwork?* Yes No Not sureIf `Yes’ please provide a description of the fieldwork you will be undertaking. (Max 1000 characters, approx 200 wordslimit).     What is the duration of your proposed fieldwork? (if known)       WeeksIn which country will you undertake the proposed fieldwork?      Proposed fieldwork supervisor (if known)       18
  19. 19. 11. Qualifications*List qualifications (whether complete or not) by level of study, starting with the highest. If you have not completedyour studies please list your anticipated end date. Applicants are required to fill out the total GPA obtained and themaximum GPA possible for each qualification noted below.Three certified copies of official transcripts and certificates MUST be included with this application. If you are selected forinterview, you MUST provide certified English translations when you attend the interview.1. Qualification name*       Secondary (High School) Vocational, Technical ( DIII or DIV )Level of study* Undergraduate (S1) Postgraduate (S2 or S3 )Name of university*      State/Province       Country*      Language of instruction*       Start date *   /   /     GPA (if applicable) Obtained       / Max End date*   /   /           Status Complete Pending results Incomplete2. Qualification name*       Secondary (High School) Vocational, Technical ( DIII or DIV )Level of study* Undergraduate (S1) Postgraduate (S2 or S3 )Name of university*      State/Province       Country*      Language of instruction*       Start date*   /   /      Obtained       / MaxGPA (if applicable) End date*   /   /           Status Complete Pending results Incomplete3. Qualification name       Secondary (High School) Vocational, Technical ( DIII or DIV )Level of study Undergraduate (S1) Postgraduate (S2 or S3 )Name of university      State/Province       Country      Language of instruction       Start date   /   /     GPA (if applicable) Obtained       / Max End date   /   /           Status Complete Pending results Incomplete 19
  20. 20. 12. English language proficiency*Applicant must have an English language proficiency of at least 5.0 in IELTS (or 500 in paper-based TOEFL or 61 ininternet-based TOEFL). The IELTS or TOEFL (Institutional or International) result must be current (a test result obtained in2011 or 2012 will be considered current). An original copy of your IELTS or TOEFL certificate must be attached to theapplication form. NO other English language test (including TOEFL prediction) result will be accepted.Is English your first language? Yes NoIf `Yes’ go to next section. If `No’ answer the following questions:Was English the language of your highest level of study? Yes NoIf `Yes’, provide a statement from the university verifying the language of instruction.Have you taken an IELTS or TOEFL test? Yes NoTest name (e.g. Date test      /     /      Overall            IELTS or TOEFL) taken scoreTest Centre/location       Phone       Website      If `No’, when do you expect to complete the      /     /      Test name      test?13. Computer literacy*Please answer the following questions to the best of your ability. This will assist Australian universities to decide whetherto provide additional tuition.Are you computer literate?* Yes NoHow regularly do you use a PC?* Occasionally Daily Weekly MonthlyDo you have experience with the following software?*Word processing software Spreadsheet software (e.g. Yes No Yes No(e.g. Word)? Excel)?Database software (e.g. Operating systems (e.g. Yes No Yes NoAccess)? Windows 2000)?Presentation software (e.g. Email software (e.g. Yes No Yes NoPowerPoint)? Outlook)?Internet browsers (e.g. Statistical packages (e.g. Yes No Yes NoInternet Explorer)? SPSS or Minitab)?14. Computer training detailsList any formal computer courses you have undertaken.Course name 1      Start date   /   /      End date   /   /     Course name 2      Start date   /   /      End date   /   /      15. Current employmentCurrent employment may include work experience and voluntary work. Please enter ‘Not Applicable’ in the ‘PositionTitle’ if you are not currently employed. You must provide a current CV. 20
  21. 21. Position title*      Organisation*      Level of position inorganisation structure       Date commenced*   /   /     (eg. Echelon and Golongan)Sector/organisation type Government/Public NGO /Civil Society PrivateBriefly describe the work of      your organisation and theservice it provides.Briefly describe your current      duties and responsibilities(max 500 characters, approx80-100 words limit)Do you intend to return to this organisation after your scholarship in Australia?* Yes NoIf ‘Yes’, what role and      responsibilities do youexpect to undertake afteryour academic studies?(max 500 characters,approx 80-100 words limit)What specific tasks do you      anticipate being able toundertake after youracademic studies? (specifyat least 3) (max 500characters, approx 80-100words limit) 21
  22. 22. 16. Previous relevant employmentOnly provide previous employment that is relevant to your application. Employment history should also include workexperience, community work and voluntary work.1. Previous positionPosition title      Organisation      Start date   /   /      End date   /   /     Duties/responsibilities      (max 500 characters,approx 80-100 words limit)2. Previous positionPosition title      Start date   /   /      End date   /   /     Organisation      Duties/responsibilities      (max 500 characters,approx 100 words limit) 17. Interview Centre *Please tick your preferred interview center. (Please note Your choice is not guaranteed.) Jakarta Medan Makassar Yogyakarta Padang Manado Surabaya Balikpapan/Banjarmasin Kupang Denpasar Jayapura 22
  23. 23. 18. Supporting statementLimit your answers to 500 characters, approx 80-100 words, per question. Attach a page if not enough room on this form.Please note word limits. Anything over this limit will not be considered.1. Why do you want to study in Australia?*     2. What skills and knowledge do you hope to gain and how do you propose to use them?*     3. How have you contributed to solving a challenge and to implementing change or reform? (Be specific andinclude: what aspect/s of your leadership knowledge, skills and practice you consider to be well established andeffective; which people or organisations you worked with to solve the problem; and what creative methods wereused.)?*       23
  24. 24. Supporting statement continued4. What specific development priority will you contribute to on your return home and how do you intend to doso?*     5. Do you wish to be considered for a supplementary Leadership Award? Yes NoRefer to the Handbook for further details on the supplementary Leadership Award.6. Do you currently have any connection or relationship to any staff employed atAusAID Posts or with AusAID’s managing contractors?* Yes NoIf `Yes’ please expand.     7. Are you subject to any criminal or civil proceedings that are currently awaiting Yes Nolegal action?*to live and undertake studies in Australia?)If `Yes’ please expand. Please note information provided here will not necessarily disqualify you from submitting this scholarship application.      24
  25. 25. 19. Professional membershipsProfessional memberships may include community, cultural, political, scientific, professional and/or educationalassociations and organisations.1. Organisation Name      Highest position held (if any)      Start date   /   /      End date   /   /     2. Organisation Name      Highest position held (if any)      Start date   /   /      End date   /   /     3. Organisation Name      Highest position held (if any)      Start date   /   /     Start date   /   /      End date   /   /      20. Communication* Where did you first learn of the Australian Development Scholarships? (tick box and specify where asked to do so) AusAID or Managing AusAID scholarship recipient Australia Awards website Contractor’s Office Friend, relative or colleague AusAID Website Home institution or university Australian Embassy or Australian institution or Publication, Radio, TV Australian Education Centre university (specify location) (specify) (specify)                   Workplace or nominating authority Other (specify) (specify)             From where did you obtain your application form? (tick box and specify where asked to do so) ADS website ADS Office AusAID Office Friend, relative or colleague DEEWR Office GoI State Secretariat Office Home institution or university AusAID project office Education Agent (specify) (specify) (specify)                   Workplace or nominating authority Other (specify) (specify)             25
  26. 26. 21. Checklist of documentary evidence*Please note: You are responsible for providing all supporting documents are provided. If you do not provide all requireddocuments your application will be rejected. THREE COPIES of the completed application form. At least one copy of the application form should have certified* copies attached of the relevant documents listed below. Where original documents are not in English, you must provide certified* copies of official English translations if you are selected for an interview.* Certified: a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notary or otherformally recognised authority. If you are unsure about who is the appropriate person to certify your documents, youshould contact the ADS Office. Required documentation: please tick if you have attached the following documents in support of your application.All applicants: (Essential)You MUST include all the essential documents. If at least one essential document is not provided, your application will beautomatically rejected. copies of birth certificate or equivalent Yes N/A proof citizenship i.e. KTP or your passport personal information pages Yes N/A current Curriculum Vitae Yes N/A official (certified* ) post-secondary and tertiary certificates/degrees Yes N/A official (certified* ) post-secondary and tertiary transcripts of results Yes N/A current (original) IELTS or TOEFL English language test results (a test result obtained in 2011 or 2012 will be considered current). TOEFL prediction test is NOT Yes N/A accepted. Masters applicants must also attach certified DIII degree certificate/transcript if using Yes N/A DIV or S1 extension certificate/transcript Doctorate applicants must also attach certified S1 degree certificate/transcript Yes N/A academic reference from S2 supervisor for Doctorate candidates Yes N/A Doctorate and those Masters applicants whose study will include at least fifty percent Yes N/A research must fill the research proposal details on page 15 of this application formAdditional Documents: (Optional)Applicants must provide the following documents if they are selected for an interview. recent photograph (3 x 4) Yes N/A official (certified* ) English translations of post-secondary and tertiary Yes N/A certificates/degrees official (certified* ) English translations of post-secondary and tertiary transcripts of Yes N/A results references from S1 supervisor for Masters candidates (if available) Yes N/A list of relevant publications, unpublished theses (for research applicants) Yes N/A statement from university that English is a language of instruction (if applicable) Yes N/A relevant correspondence with an Australian university (if available). Yes N/A official (certified*) English translations of birth certificate Yes N/AIMPORTANT: • Attach only certified copies of documents. DO NOT attach original documents. • Application forms and documents will not be returned. 26
  27. 27. 22. Conditions of ScholarshipsWARNING:In section 22, 23 and 24 you will be agreeing to important conditions attached to your award and your study in Australia.Failure to comply with these conditions will mean that you may incur a debt to the Government of Australia and yourscholarship may be terminated.DO NOT sign the declaration at the end of section 23 and 24 until you fully understand the conditions of the scholarshipaward. If you have any problems understanding Section 22, 23 and 24 you are strongly advised to seek clarification ofthese conditions from the Australia Awards Office.If you are offered a scholarship you will be asked to agree to certain conditions before accepting the scholarship. The mainconditions are set out below for your information.In accepting an Australian Development Scholarship, you will be asked to: • take up the ADS in the academic year for which it is offered; • complete a full study program during the course of their scholarship; • not hold another Australian Government scholarship at the same time as the ADS; • participate in the Pre-Departure Briefing arranged by the Post, and the university’s compulsory Introductory Academic Program (IAP) on arrival in Australia; • reside in Australia for the duration of the ADS (apart from holidays, reunion visits or fieldwork visits to their home country); • complete their ADS award within the period stipulated in their Student Contract; • only undertake the approved program for which the ADS is offered and abide by the rules of the university; • maintain an appropriate study load and achieve satisfactory academic progress in the program for which the ADS was offered; • participate in all activities associated with the approved course of study, including all lectures and tutorials, submit all work required for the course (e.g. assignments or essays) and sit for examinations; • not undertake any additional off-scholarship tertiary studies during their time in Australia on an AusAID Student Visa; • be aware that any employment undertaken during term times may compromise academic progress; • liaise with the Student Contact Officer at the university regarding any proposed changes to the approved program and acknowledge that approval is required from the university, AusAID and Partner Government before any changes are made; • agree to AusAID collecting information concerning the Student or dependants and passing that information on to other relevant parties, if necessary; • advise AusAID immediately, via the Student Contact Officer at the university, if they marry a person who is an Australian or New Zealand citizen, or who has permanent residence status in Australia or New Zealand. The change in a student’s marital status may affect eligibility to maintain the ADS Scholarship, and the Debt to the Commonwealth may apply if the student does not return to their home country for a period of 2 years; • return to their country of citizenship for two years at the completion of their study/research program in Australia;. • be aware that a Debt to the Commonwealth of Australia will be incurred if a Student fails to return to their home country, or if they apply for Permanent Residence or for a visa to remain in or return to Australia within the two year period; and • that any time spent in Australia during the two year return home period will accordingly extend the end date of the two year period; • agree that their ADS may be terminated at any time for failure to make satisfactory academic progress, failure to comply with the laws of Australia, misconduct, breaches of the contract between the Student and the Commonwealth of Australia including breaches of the conditions of the ADS or of the AusAID Student Visa or if they apply to change their visa status. 27
  28. 28. Conditions of Scholarships continued Subject to your fulfilling these conditions AusAID will provide the following, (either directly or through the Australian university): • Pre-Course English – provision of English for Academic Purposes training prior to commencement of studies in Australia (including an in-Indonesia stipend) • In-Indonesia Stipend for the period from the commencement of Pre-Course English to the date of awardee mobilisation. This does not apply to any deferral period. • Medical examination and x-ray costs in order to comply with Student Visa requirements • AusAID Student Visa and Student Dependant Visa 28
  29. 29. • Outward Airfare (economy- one way) from the airport closest to the awardee’s home location to the international airport closest to the Australian university selected for study by the awardee • Overseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for any accompanying family in order to satisfy visa requirements). • Establishment Allowance payable into the awardee’s bank account after arrival in Australia • Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to living expenses (CLE). • Introductory Academic Program (IAP) for a period of 4-6 weeks undertaken prior to the commencement of Masters or PhD studies • Masters OR PhD Tuition Fees – including all compulsory fees for the course in which the awardee is accepted into • Supplementary Academic Support - provided where it is deemed essential to assist awardees to pass course subjects. • Fieldwork - holders of a scholarship where research comprises at least 50 percent of the program may receive a return economy class airfare to Indonesia to undertake essential fieldwork. • Reunion Airfare - is available to a ‘single’ awardee after the successful completion of the first year of study; subsequent reunion airfare entitlements will be available on an annual basis for the duration of the ADS, except for the final year of the ADS. • Homeward Airfare (economy- one way) from the international airport closest to the Australian university selected for study by the awardee to the airport closest to the awardee’s home location. Your university will provide for: • instruction and facilities necessary to complete the specified course • appropriate academic and welfare support for the duration of your studies • airport reception and temporary accommodation arrangements on arrival in Australia.23. Nominating Agency Declaration - required for Public sector applicants only* (NB: to be completed by the staff member within your organisation authorised to release staff for overseas study - for example staff from the International Relations Bureau (BKLN) / Centre for Education and Training / the Planning Bureau / Rector from the university as appropriate. Applicants from outside Jakarta must have the approval and nomination of their relevant Kakanwil or Kadinas and approval from Bupati or Governor (or representative) where necessary.) Please note that your signature on this form signifies your agreement to the following: • to release the applicant from work duties while he/she attends English for academic training. This training is full- time and compulsory • to release the applicant from work duties after English for academic training to study in Australia, and process their official passport and exit permit • to cover the cost of travel to and from English for Academic Purposes training (Bali/Jakarta) • to cover the cost of travel to the point of departure (Bali/Jakarta) prior to travel to Australia to cover the cost of medical examinations for the applicant. A medical examination is an Australian Immigration requirement to receive a student visa • to select a field of study and level of study appropriate to the agencys needs. Please also note that if the application is for Doctorate level study, the signature by the authorised staff member confirms that the applicant is a lecturer/researcher/key planner or policy maker and that Doctorate level studies are essential for his/her future research and /or teaching responsibilities. Name of Ministry/Employer       29
  30. 30. Name of Applicant       Applicant’s Position title       Applicant’s Level of position in organisation structure       Date commenced   /   /      (eg. Echelon and Golongan) How long have you known the applicant and       in what capacity? Please make any additional comments about       the applicants potential or personal qualities which you feel would be helpful to the ADS Selection Team. Ministry/Agency Representative signature* On behalf of the ministry, I the undersigned, agree to be bound to the above commitments and strategies Full Name       Signature & stamp Position       Email             Mobile       Date    /   /     24. Applicant’s authorisation, agreement, declaration and signature* 30
  31. 31. Authorisation AusAID 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 AusAID, or its appointed managing contractor, to access and/or obtain information, including copies of any of my relevant academic records/reports from the Australian University(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 university while studying under an Australian Development Scholarships • to brief relevant Australian officials, Ministers and members of Parliament. Should I receive an Australia Award, I consent 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 AusAID’s offshore Posts and Australian universities, concerning the Australian Development Scholarships. I authorise AusAID to disclose the personal information collected in this form to other Australian Government departments for the purpose of promoting and managing the Australian Development Scholarship. Understanding I understand and confirm that: • I have read and complied with the Scholarships Handbook and that the contents of my application are true and correct • AusAID has the right to vary or reverse any decision regarding an Australia Development Scholarships 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 Development Scholarships, I agree that I will: • undergo a police or character check before my Australia Development Scholarships is confirmed • immediately provide AusAID with details of any incident that may reflect badly on the prestige of an Australia Development Scholarships • act in a manner befitting a recipient of an Australia Development Scholarships • 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 Scholarships. 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. Full Name Signature Date    /   /                 25. Ministry of State Secretariat of the Republic of Indonesia use only 31
  32. 32. Endorsement by the Government of Indonesia( To be completed by Head, Bureau of Technical Cooperation, Ministry of State Secretariat of the Republic of Indonesia )On behalf of the Government of Indonesia, I certify that I have examined the documents attached to this form and amsatisfied that they are authentic and relate to the applicant.I certify that the maximum level of study, field of study and length of award proposed in this application are appropriateand in accordance with the Governments training policy.I endorse the applicant for an Australian Development Scholarship.Name of certifying officer      Title      Organisation      Official Stamp Signature Date    /   /                 32

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