Australian Development Scholarships

Australian Development Scholarships
2o1B Intake Application Form
Instructions
Please print neatly using block letters (huruf cetak) and black ink
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Before completing this form, you must read the Australia Development Scholarships Handbook (The Handbook)
and your Country's profile, available on the AusAlD Website (see below) or from the AusAlD/Managing
Contractor's office in Indonesia. Brief information about the program is also included in this application form. Also
see www.adsindonesia.or.id
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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 August2072 at the
Australia Awards Office at Gedung Wirausaha, 7th Floor. Jl. H.R. Rasuna Said Kav.G-S
Kuningan, Jakarta 12940.
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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.
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AusAlD'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).
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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.
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lf 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 AusAlD reserves the right to change these conditio4s at any time.
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Submitting this application does not guarantee that you will receive a Scholarship.
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lf 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).
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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.
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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.
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In cases where information supplied by candidates is found to be inaccurate or incorrect, an award offer may be'
revoked without notice.
General Information Notes
Australian Development Scholarships (ADS) provide opportunities
for
Indonesians
POSTGRADUATE level.
to studv in Australia at
Up to four hundred and seventy five scholarships are expected to be awarded in 2013 for commencement
in
201312014 including twenty five Australian Leadership Award Scholarships (ALAS). Candidates must undertake studv
in one of the four areas of development priority (see page 3).
ADS are offered in two main categories: 'Public Sector Gategory' and 'Open Category'.
Public sector applicants are employees from Government organizations, state universities and state owned
enterprises. Their applications must be approved by training or foreign cooperation bureaus (BKLN) of their local or
central agencies before being submitted to the ADS Program Office. Public sector candidates from government
agencies outside Jakarta may apply directly to the ADS Program Office with the approval of their relevant Kakanwil or
Kadinas and approval from Bupati or Governor (or representative) where necessary. Calon pegawai Negeri Sipil
are not eligible to apply.
Open Category applicants are from private organisations and universities and this category is also open to recent
university graduates. No prior Government approval is required for people applying in the Open Category, and
applications are to be submitted directly to the Australia Awards Office. They require, where relevant, tne
endorsement of the agency, institution or private university in which the applicant is working or studying. Applications
are 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 the
ADS Program. Candidates within this category must be identified by their home organization and must not apply to
the ADS Program independently of their employer.
'Targeted Category' candidates are employed by organisations which are identified by the Government
of Indonesia
and Government of Australia (through AusAlD) as being strategically aligned with the Development priorities of the
Government of Indonesia.
Scholarships are for full-time study for a Masters or Doctorate degree from Australian tertiary institutions. The
scholarship provides up to nine months full-time language and academic preparation in Indonesia. Students must
achieve 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 are
encouraged to apply.
Women and candidates in provinces within the geographic focus of AusAlD's Country Strategy (see page 4) are also
encouraged to apply.
Elisibility
IN GENERAL CANDIDATES MUST:
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be an lndonesian 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 AusAlD
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 AusAlD Scholar who has been on AusAlD scholarship/s in Australia for five years will not be
eligible to apply for another AusAlD scholarship until they have been home for ten years)
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be applying to commence a new course of study and not be seeking support through ADS for a course already
commenced in Australia.
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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 lmmigration and Citizenship (DIAC) for an AusAlD student
visa
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and
be able to satisfy the admission requirements of the Australian university at which the Scholarship is to
undertaken.
be
SPECIFICALLY, CANDIDATES MUST:
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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 AusAlD 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 201 1 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]5
application form.
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for awardees with a disability as declared on the ADS
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 AusAlD 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{ime (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 AusAlD's 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 studv follows.
Australia
Indonesia
Partnership
Priority
Sustainable Growth and
Economic Management
Democracy Justice and
Good Governance
economic policy
and management, reducing
constraints to growth in
Investing in People
Safety and Peace
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public
financial management.
Befter quality, access
and govemance in
education, and befter
health access and
systems
humanitarian needs,
emergencies and
.
.
Development
Areas (PDA)
Description of
PDA
I mproving
infrastructure and
ctivity, a nd i m p rovi ng
natural resource
management, environmental
governance and response to
climate change.
p rod u
Australia
Indonesia
Partnership
Priority Fields
of Study
.
o
o
.
.
e
o
.
o
.
Natural Resource
Management
Agriculture
Aquaculture/fisheries
Forestry
Climate Change
Economics
InfrastructurePlanning
Water and Sanitation
Rural GroMh
Small and medium
enterprise development
o
.
o
o
o
o
.
.
Law, legal and
judicial systems
Political Science and
Government
Publicadministration
Public expenditure
management
Public Sector
Reform
Environmental Law
Anti-corruption
Decentralisation
Monitoring &
Evaluation
.
o
o
.
.
.
o
.
o
o
Communicable
Disease Prevention
Health
Management
Health Services
Maternal and Child
Health
Women and
Gender Studies
Disability Services
Public Health
Education and
Training
Education
Management
Human Resource
Development
Childhood Special
Education
Improving responses fo
vulnerability to
disasters, and
improving capacity to
ensure transport
s.ecurity and to counter
threats from
transnational crime.
.
.
.
r
.
o
Conflict Resolution
Disaster
Prevention and
Management
Transport Safety
Transnational
Crime Prevention
Development
Studies
lnternational
Studies
NB:
lf your study area is not listed here, you may still apply for a field of study related to the work of AusAlD 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 AusAlD and Government of Indonesia - State Secretariat.
SELECTION QUOTAS:
ln the
up to four hundred and seventy five (475) ADS scholarships are available for
including
twenty five (25) Australian Leadership Award Scholarships (ALAS). The
2013120'14
201212013 ADS cycle,
commencement
in
scholarships are allocated as follows:
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213
of all awards will be offered in the 'Public Sector' category
113
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 Easf Nusa Tenggara, Wesf i/usa Tenggara, Papua, West Papua, and
Aceh)
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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 AusAlD activities.
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an eoual 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:
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meet the minimum English language requirement of their chosen Australian university (usually IELTS of 6.5 with
no band less than 6.0)
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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
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receive a letter of acceptance from an Australian university
meet Australian immigration requirements for a student visa
receive Government of Indonesia endorsement
be medicallv fit to commence studies in Australia
ln Australia, scholarship recipients must:
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abide by the conditions of the scholarship and the rules of Australian tertiarv institutions
abide by the rules and regulations governing a student visa
act in a way that will not bring disrepute to AusAlD, 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. lf
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 exoire 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-lndonesia stipend)
ln-lndonesia Stipend for the period from the commencement
mobilisation. This does not apply to any deferral period.
of Pre-Course English to the date of awardee
Medical examination and x-ray cosfs in order to comply with Student Visa requirements
AUSAID Student Visa and Student DependantVisa
Outward Aiffare (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 anv
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)
(cLE).
lntroductory Academic Program (IAP) tor
Masters or PhD studies
Masfers OR PhD Tuition Fees
-
- payment of a fortnighily contribution to living
a period of 4-6 weeks
expenses
undertaken prior to the commencement of
including all compulsory fees for the course in which the awardee is acceoted
into
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Supplementary Academic Support
- provided where it is deemed essential to assist awardees to oass
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 fieldworr<.
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 universitv 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 AusAlD and
immigration requirements. Families are normally permitted to join eight (8) weeks after the awardee's arrival.
Useful websites
Australia Awards
Australia Awards
-
: http://austral iaawards.
gov. au/
Development Scholarships: http://www.ausaid.gov.au/scholar
Australian Development Scholarship (ADS) Indonesia: http://www.australiaawardsindo.or.id
Visas
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Department of lmmigration and Citizenship: http://www.immi.gov.au
Studying in Australia: http:i/www.studyinaustralia.gov.au
Australian 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 bv
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,
003413
Australian Development Scholarships
2o1B Intake Application Form
Provide supporting documentary evidence of your full name, date of birth, gender and country of
citizenship. For example, the identification page of your passport or other official identification
document issued by your country of citizenship.
*
Attach a recent
passport size photo.
3x4cm.
Denotes mandatorv field
I Mr IMrs
! Otnerletease specify)
Enter your family name and other names as shown in your
Birth Ceftificate, Passport or other official identification
document. lf you have only one name, enter it in both fields
Gender*
nMale
Which country are you living in now?-
Have you applied, or are you intending to apply, for permanent
residency or citizenship in Australia or New Zealand?.
nYes [ru0
National ldentity Number
(KTP No.)
Passport no.
(provide if you have a
passport)..
lssue
date
I
nFemale
you
(please check that youf contact details are conect. The scholarship application takes several months to be finalised. lf
proceed.)
your
will
not
application
cannot be contacted,
Residential address
Mailingaddress
Address line
(Provide letails onlv if this is different to your current residential address
)
1
Address line 2
Address line 3
Town/City
Postal code litanyl
State/Province
Country
Phone and
email
(Provide at least one contact number.)
Home phone no.-
Work phone no.
Mobile no.
Fax no.
Email
1if
anyl
1
Email2
Current Work address
(please provide your current work address where you can also be contacted. lf you cannot be contacted, your application
will not oroceed.)
Address line
1
Address line 2
Address line 3
Town/CityState/Province*
Country-
Postal code
1if
anyl
d
rg; nav€ dependants (spouse and/or children under 18 years of age), provide their details even if they will not
a'ccompany 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 in
Australia during your scholarship, from the Department of lmmigration and Citizenship (DIAC) or by contacting the
university 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*
tI
Date of birth.
tI
l dd/mm/
uu/ililil/Yyyy
Gender*
I
Passport no.
Provide
lssue
ln
n4ate
date I
t
|
|
n
Female
if spouse
*
has a passporf.
Expiry
Date
Country of
citizenship
Will your spouse accompany you to Australia?*
f,
T
Yes
No
Provide details of any dependent children and indicate if they willjoin you in Australia.
A dependent child is the child or stepchild, of yourself or your spouse, who is not married or engaged to be manied and
has not turned 1 8 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 be
obtained from the Australian Government Department of lmmigration and Citizenship website or by contacting the
university where you want to study.
Child
1
Will this child accompany you to
Australia?*
!
Yes
n
ruo
!
Issue
Child
2
Will this child accompany you to
Australia?*
date t
n Yes I
Male flFemale
t
t'to
Family name
Given names
Date of birth
dd/mm/yyyy
Gender
Counky of citizenship
Passport no.
lssue
date
Provide if child has a
passporl. *
Expiry
t
t
date t
t
n Vale n Female
Will this child accompany you to
Australia?*
n
Yes
lssue
I
No
date l
I
date I
t
Expiry
provide details of a person that can be contacted in case of an emergency. This may be a relative or a friend'
Title.
nMr
n
I
Please specify
offrer
Mrs
! Miss l!
nus
Family name-
Relationship to
you*
Given name-
Gendef
Home phone*
Work phone
Mobile phone
Fax (if any)
n Male n
or
Female
Emaill
Email2
Address line 1.
Address line 2
Address line 3
Town/CityState/Province'
Postal code
(if any)
Please check that the contact details are correct
Country.
Only include details of poslsecondary school scholarships or fellowships'
Have you previously been awarded a scholarship or a fellowship?*
Z Scholarshiplfellowship title
Sart date
Qualifi cation (if applicabte)
University
Have you previously applied for an AusAlD scholarship but were
unsuccessful?*
lf "Yes" how many times have you previously applied for ADS?
Have you previously been interviewed by ADS?*
lf 'Yes', in which years?
AUSAID strongly encourages applications from peopte with disabitity
Discriilnation Act, Australian education institutions have
who are otherwise
eligible for
a schotarship.
to provide 'reasonable adjustments'to sfudents
Io assess the likely suppott needs, appropriate assisfance, and the capacity of relevant institutions
lJnder the Disabitity
with disabitity toasslsf access
to sfudy.
to providefhe asslslance, awardees with a
disability/special need nust provide detaits of the disabitity 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 banier-free learning environment.
Modifications to physical or learning environments, inctuding additional educational
supporls such as srgn interpreters and captioning, may be
available depending on the relevant lnstitution's capacrty. AusAlD witt advise
the Institution of any special requirements associated with an
Awardee so that the lnstitution can pass these details to the lnstitution's
Disability Liaison officer prior to the Awardee arriving on-campus.
Where an lnstitution is not able to provide lhe asslsfance requested,
other tnstitutions may be recommended.
Do you identify as having a disability or do you work in a disabilityfocused organisation?*
*Under
Australian law, disabitity includes physicat, intellectual, psychiatric, sensory,
neurological, learning disabilities, physical disfigurement, and the presence in the body
of
drsease-causing o rganisn s
(hftp ://www.
h
re oc. g ov. a
u/d i sa bi I ity _rig hts/d d a 4
u i d e /w h o /w h o.
htm t)
lf yes, please provide details if you require special assistance or equipment
to participate in the scholarship selectto{]
processes or to live and undertake studies in Australia?
nopen
Xpuutic
lf "Open", please indicate if your application is from:
lf "Public", please indicate if your application is from:
!
f
Private university
Private individual
I
I
f
GovernmentDepartment
State-ownedEnterprise
State University
AusAlD will consider offering you a scholarship only if your course of study will contribute to the longterm development
needs of your country. Note that the proposed program of study should be appropriate to your academic qualification and
work experience.
Requested Level of study(You will not be allowed to
upgrade your course from the
level at which you are first
placed.
E
n
Type of study* (Masfers
Masters
coursework program can contain a
research project up to 30% of the
Doctorate (PhD)
Masters. Candidate decide the topic
during course)
X
n
n
Coursework
Research
Combination
Research background of Doctorate(PhD) candidates only:*
studies? (Recommended)
!
Yes
n
No
Proposed field of study*
You are required to:
Australia
Indonesia
Partnership
Sustainable Growth
and Economic
Priority
Management
T-l
Development
Areas (PDA)*
Description
of PDA
Improving economic
policy and management,
reducing constraints to
g rov'rt
h i n i nf rastru ctu re
and productivity, and
improving natural
resource management,
environmental
governance and response
to climate change.
Australia
Indonesia
Partnership
Priority
Fields of
Study (PFS)-
n
I
I
!
!
!
I
Strengthening the
capacity, accountability
and responsiveness of
Better quality, access and
governance in education,
and better health access
and systerns
lega[ democratb and
oversight institutions, and
improving local
government and public
financial management.
Agriculture
I
Climate Change
Economics
Infrastructure
Water and Sanitation
Smalt and medium
enierpnse
development
Law, legal and judicial
n
systems
Aquaculture/fisheries
Forestry
Safety and Peace
T
n
L_l Kural uroMn
I
Investing in People
Natural Resource
Management
Planning
n
Democracy Justice
and Good
Governance
!
n
Potitlcat Science and
Government
PuUticadministration
Puntlc expenditure
management
Health Management
Health Services
Maternal and Child
Health
!
Women and Gender
Studies
Disability Services
Decentralisation
n
n
E
Monitoring &
Evaluation
n
Ll ruDilc uector KeTorm
!
!
n
!
n
n
n
Communicable
Disease Prevention
Environmental Law
Anti-corruption
n
n
Public Health
Education and
Training
Education
Management
Human Resource
Development
Childhood Special
Education
lmproving responses to
humanitarian needs,
me rge nci e s and v ulnerability
fo dlsasfers, and improving
capacity to ensure transport
security and to counter threats
from transnational crime.
e
n Conflict Resolution
n Disaster Prevention and
Management
n Transport Safety
n Transnational Crime
il
n
Prevention
Development Studies
International Studies
aare iou obtained information from the ADS Information cD,
or from the ADS
'r€bs{te
regarding study options in Australia?
Please describe the efforts you have undertaken so far
to obtain information on your study options in Aushalia.
Following Australian universities are under contract to AusAlD
to provide courses for ADS awardees. Awardees are
required to find a suitable course of study at one of these Australian
universities. phD candidates must find a supervlsor at
one of these universities' Please visit the following website for more details
on Australian Educational Institutions and
courses - CRICOS: http//cricos.deewr.gov.au
o
.
o
.
.
o
.
o
c
o
.
o
.
.
Australian Maritime College
Australian Catholic University
Camegie Mellon University
Central Queensland lJniversity
Charles Daruin University
Charles Stuft University
Cuftin University ofTechnology
Deakin University
Edith Cowan University
Griffith University
James Cook University
La Trobe University
Macquarie University
Monash Univeisity
.
.
.
t
c
.
.
.
.
.
.
.
.
.
Murdoch University
Queensland University of Technotogy
RMIT University
Southern Cross University
Swinbume University of Technology
The Australian Nationat University
The Flinders University of South Austratia
The University of Adelaide
The University of Melboume
The University of eueensland
The University of Sydney
The University of Westem Australia
UCL School of Energy and Resources
University of Ballarat
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University of Canbena
University of Newcastte
Universrty of New England
Universtty of New South Wales
UniversrU of South Australn
Universrty of Southern eueenstand
UniversrU of Tasnania
University of Technology, Sydney
University offhe Sunshlne Coasf
Universrty of Western Sydney
University of Wollongong
Victoria University
Bond University
The University of Notre
Dane Australia
lf you are selected for the scholarship the Aushalia Ayardg Office will
forward your application to your prefer Aushalian
university and course of study. You need to decide which Australian university you
want to attend and choose an
appropriate course. You should choose two courses of study. You are encouriged
to choose two different Australian
universities rather than two different courses at the same university. lf your
application for the first cnoice of stuOy is
unsuccessful, AusAlD will fonrvard your application to your second
choi;e. The CRICOS .oJr ri*loui-.orr.. .rn o.
found on the commonwealth Register of lnstitutions and courses
for Overseas students
tcilCosj w.orit.
http//cricos.deewr. gov. au
To find out about the content of specific courses, you should refer
to the individual Australian university websites. This
information can also be found on the ADS Informition cD which can be
obtained from the Australia Awards office or ADS
website http://www.australiaawardsindo. or, id
Course title or particular focus
area withln your identified
proposed Field of Study..
CRICOS code ff
appticabte),
Course duration (weeks)
(if applicable)
Minimum English
language proficiency
required for the course
(IELTS)fif appticabre)
Course title or particular focus
area within your identified
proposed Field of Study.-
CRICOS code
(if applicable)-
Course duration (weeks)
(if applicable)
Minimum English
language proficiency
required for the course
(IELTS) (if applicabte)
A formal offer of admission will not be required however it is expected serious
PhD candidates will have made preliminary enquiries to possible Australian
universities regarding their study.
Have you discussed your proposed course with a member of staff from any
Australian university? This is highly recommended for PhD applicants. lf "Yes",
n
Yes
Euo
n
Yes
nruo
please attach any relevant correspondence with Australian universities.
Are there any special subjects or skills development that you would like to include
in vour choice?
lf "Yes" please give details. (Note that ADS does not include the practical training period required for professional
regishation, e.g. medical internship, legal articles etc. Applicants are expected io complete such practical training in their
own country).
t4
Complete this section if the studies will be by Research or a combination of
Research and Coursework. E.g. Doctorate
or Masters by Research. Otherwise proceed to next question. Answers should
be concise but sufficient io explain the
nature of your research proposal to the selection panel. Please note
word limits. Anything
this limit will not be
".'-'e over
-
considered.
Research title
(max 250 characters,
approx 30-50 words limit)
What is the background to
the research being
proposed? (maximum 150
/ + 1,000
characters)
words
Provide a Research
Statement (purpose of
study) to accompany the
proposed research. This
can include a statement on
what is specialand unique
about the research?)
(maximum 100 words / +
700 characters)
What hypothesis are you
testing in your proposed
research? (maximum 50
words
/ + 350 characters)
What are ihe objectives ol
the proposed research?
(maximum 200 words / +
1,300 characters)
'
What is the
methodology/skucture in
your proposed research?
(include comments on
measurements, data
sources, methods of
analysis and timelines)
(mafimum 200 words / +
1,300 characters)
Have you published any
research to date? (include
texts, journal articles
providing full citation)
-
Which university do you
consider appropriate for
your proposed studies?
Why? (maximum 50 words
/
+ 350 characters)
Have you considered a
oossible research
supervisor? Why this
selection?(maximum 50
words
/ + 350 characters)
What is the relevance of
the proposed research to
Indonesia?
Does your proposed research include
fieldwork?. I n yes
I
n Uo
I
n
ruot,rr.
lf 'Yes' please provide a description of the fieldwork you will be undertaking . (Max 1000 characters, approx 200 words
Iimit).
What is the duration of your proposed fieldwork? (if known)
Weeks
In which country will you undertake the proposed fieldwork?
Proposed fieldwork supervisor (if known)
16
List qualifications (whether complete or not) by level of study, starting with the highest. lf you have not completed
your studies please list your anticipated end date. Applicants are required to fill out the total GPA obtained and the
maximum GPA possible for each qualification noted below.
Three certified copies of official hanscripts and certificates MUST be included with this application. lf you are selected for
interview, you MUST provide certified English translations when you attend the interview.
I
I
Secondary (High School)
Vocational, Technical
(Dllln
I
Undergraduate (S1)
n
Complete
tr
Secondary (High School)
n
Undergraduate (Sl)
!
or
DIVI)
Postgraduate
Pending
I
results
(S2[ or S3!)
lncomplete
2. Qualification name*
n
Vocational, Technical
n
Postgraduate
Level of study*
(Dllln orDlVn)
(S2f]
or
S3n)
or
$n)
Name of universitv*
State/Province
Country*
Language of instruction*
GPA
(if applicable)
Status
3.
Start
Obtained
/ Max
End
I
Complete
n
Secondary (High School)
tr
Undergraduate (Sl)
!
Pending
date- |
date* |
results
I
I
I
Incomplete
Qualification name
n
Vocational, Technical
n
Postgraduate
Level of study
(Dllln orDlV[)
(S2n
Name of university
State/Province
Country
date I
End date t
Language of instruction
Start
GPA (if applicabte)
Obtained
Status
I
/ Max
Complete
!
Pending
t7
results
I
t
t
lncomplete
Applicant must have 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 (lnstitutional or International) result must be current (a test result obtained in
2011 or 2012will be considered current). An original copy of your IELTS or TOEFL certificaie must be attached to the
application form. NO other English language test (including TOEFL prediction) result will be accepted.
ls English your first language?
lf ' Yes' go to next section. lf
'
No' answer the following quesflons:
Was English the language of your highest level of study?
nYesnNo
lf'Yes', provide a statement from the university verifying the language of instruction.
nYesnNo
Have you taken an IELTS or TOEFL test?
Test name (e.9.
IELTS or TOEFL)
lf 'No', when do you expect to complete the
test?
Please answer the following questions to the best of your ability. This will assist Australian universities to decide whether
to provide additional tuition.
nYeslNo
Are you computer literate?*
I Weekly I
How regularly do you use a PC?*
Do
Monthly
you have experience with the following software?*
Word processing software
(e.9. Word)?
trYeslNo
Database software (e.g
Access)?
nYesnNo
Operating systems (e.9.
Windows 2000)?
nYestrNo
nYes n
Email software (e.g
0utlook)?
nYestrNo
Statistical packages (e.9.
SPSS or Minitab)?
nYesnNo
nYesnNo
No
nYesnNo
List any formal computer courses you have undertaken.
curent employment may include work experience and voluntary work. Please enter'Not Applicable' in the 'position
Title' if you are not currently employed. you must provide a current CV.
Level of position in
organisation structure
(eg. Echelon and Golongan)
n Governmenupublic n
uco /civil
society
[private
Briefly describe the work of
your organisation and the
service it provides.
Briefly describe your current
duties and responsibilities
(max 500 characters, approx
80-100 words limit)
Do you intend to return to this organisation after your scholarship in Australia?*
lf 'Yes', what role and
responsibilities do you
expect to undertake after
your academic studies?
(max 500 characters, approx
80-100 words limit)
What specific tasks do you
anticipate being able to
undertake after your
academic studies? (specify
at least 3) (max 500
characters, approx 80-1 00
words limit)
79
nYestrNo
Only provide previous employment that is relevant to your application. Employment history should also include work
experience, community work and voluntary work.
Duties/resoonsibilities
(max 500 characters, approx
80-100 words limit)
Duties/resoonsibilities
(max 500 characters,
approx 100 words limit)
Please tick your prefened interview center. (Please note Your choice is not guaranteed.)
E
I
!
!
Jakarta
Yogyakarta
Surabaya
Denpasar
I
f,
I
I
tr,tedan
Padang
aatikpapan/Banjarmasin
Jayapura
E
!
!
Makassar
Manado
t<upang
Limit your answeis 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
2.
study in Australia?*
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 and
include: what aspecUs of your leadership knowledge, skills and practiceyou consider to be well established
and
effective; which people or organisations you worked with to solve the problem; and what creative
methods were
used.)?*
21
4. What specific development priority will you contribute to on your return home and how do you intend to do
so?*
5. Do you wish
to be considered for a supplementary Leadership Award?
Refer to the Handbook for further details on the supplementary Leadership Award.
nYesnNo
6. Do you currently have any connection or relationship to any staff employed at
AusAlD Posts or with AusAlD's managing contractors?*
nYeslNo
to any criminal or civil proceedings that are currently awaiting
legal action?*to live and undertake studies in Australia?)
nYesnNo
7. Are you subject
/f'Yes'p/ease expand. Please note information provided here will not necessaily disquality you from submiftrng this scholarship application,
aa
Professional memberships may include community, cultural, political, scientific, professional and/or educational
associations and organisations.
Highest position held (if any)
Highest position held (if any)
Highest position held (if any)
Where did you first learn of the Australian Development Scholarships?
(tick box and specify where asked to do so)
n
AusAl D scholarship recipient
n
Friend, relative or colleague
n
Australian Embassy or
Australian Education Centre
(specify Iocation)
n
n
n
Auskalia Awards website
tr
AusAlD Website
n
Australian institution or
university
(specify)
Workplace or nominating authority
n
AusAlD or Managing
Contracto/s Office
Home institution or universitv
Publication, Radio, TV
I
(specify)
Other
(specify)
x
(specify)
From where did you obtain your application form? (ticr box and specify where asked to do so)
n
ADS website
f
ADS Office
x
Friend, relative or colleague
T
DEEWR Office
I
Education Agent (specify)
Home institution or university
I
(specify)
Workplace or nominating authority
n
(specify)
!
x
T
(specify)
Gol State Secretariat Office
AusAlD project office
n
Other
AusAlD Office
(specify)
Pleasenote: Youareresponsibleforprovidingallsupportingdocumentsareprovided.lfyoudonotprovideallrequired
documents your application will be rejected.
listed below.
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 other
formally recognised authori$. lf you are unsure about who is the appropriate person to ceftify your documents, you
should contact the ADS Office.
Required documentation: please iick if you have attached the following documents in support of your applrcation.
All applicants: (Essential)
You MUST include all the essential documents. lf at least one essential document is not provided, your applicatron will be
automaticallv reiected.
copies of birth certificate or equivalent
proof citizenship i.e.
lYes n
Xves f nn
ruln
KTP or your passport personal information pages
curreni Curriculum Vitae
nYes n N/A
official (certified* ) post-secondary and tertiary certif icates/degrees
trves n ruln
official (certified* ) post-secondary and tertiary transcripts of results
lves !
run
f,ves I
N/A
current (original) IELTS or TOEFL English language test results (a test result obtained
in 2011 or 2012will be considered current). TOEFL prediction test is NOT
accepted.
Masters applicants must also attach certified Dlll degree certificate/transcript if using
DIV or S1 extension certificate/transcript
Doctorate applicants must also attach certified
Sl
degree certificate/transcript
academic reference from 32 suoervisor for Doctorate candidates
Doctorate and those Masters applicants whose study witl include at least fifty percent
research must fill the research proposal details on paqe 15 of this application form
IYes fl N/A
lves I un
lYes n nn
IYes I
Nn
nyes n
N/A
Additional Documents: (Optional)
Applicants must provide the following documents if they are selected for an interview.
recent photograph (3 x 4)
official (ceilified* ) English translations of posfsecondary and tertiary
certificates/deorees
official (certified* ) English translations of posfsecondary and tertiary transcripts of
results
l-lYes
I-] uln
IYes
D
N/A
list of relevant publications, unpublished theses (for research applicants)
Ives I un
lYes X un
statement from university that English is a language of inskuction (if applicable)
IYes fl N/A
relevant correspondence with an Australian university (if available).
[ves
n run
official (certified.) English translations of birth certificate
fYes
X un
references from S1 suoervisor for Masters candidates (if available)
NA
WARNING:
ln 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 oiAustralia ano
vour
scholarship may be terminated.
D0 NOT sign the declaration at the end of section 23 and 24 until you fully understand the conditions of the scholarship
award. lf you have any problems understanding Section 22,23 and 24 you are strongly advised to seek clarification of
these conditions from the Australia Awards Office.
lf you are offered a scholarship you will be asked to agree to certain conditions before accepting the scholarship. The
main
conditions are set out below for your information.
In accepting an Australian Development Scholarship, you will be asked to:
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take up the ADS in the academic year for which it is offered;
complete a full study program during the course of their scholarship;
rot 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 (lAP) 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.9. assignments or essays) and sit for examinations;
not undertake any additional off-scholarship tertiary studies during their time in Australia on an AusAlD Student
Visa;
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.
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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 approveo
program and acknowledge that approval is required from the university, AusAlD and Partner Government before
any changes are made;
agree to AusAlD collecting information concerning the Student or dependants and passing that information on to
other relevant parties, if necessary;
advise AusAlD 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 oi 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 Aushalia 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 AusAlD Student Visa or if
they apply to change their visa status.
)q
Subject to your fulfilling these conditions AusAlD will provide the following, (either directly or through the Australian
university):
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o
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Pre'Course English - provision of English for Academic Purposes training prior to commencement of studies in
Australia (including an in-lndonesia stipend)
In'lndonesia 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
AusAlD Student Visa and Student Dependant Visa
Outward Airfare (economy- one way) from the airportclosest to the awardee's home location to the
international airport closest to the Australian university selected for study by the awardee
o
o
.
Overseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for anv
accompanying family in order to satisfy visa requirements).
Establishment Allowance payable into the awardee's bank account after anival in Australia
Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to living
expenses (CLE)
o
Introductory Academic Program (lAP) for a period of 4-6 weeks undertaken prior to the commencement of
Masters or PhD studies
r
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.
.
.
r
Fieldwork - holders of a scholarship where research comprises at least 50 percent of the program may recetve
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. exieot
for the final year of the ADS.
Homeward Airfare (economy- one way) from the international airportclosest to the Aushalian university
selected for study by the awardee to the airport closest to the awardee's home location.
Your university will provide for:
o
.
o
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.
(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 approvil 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:
'
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o
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r
to release the applicant from work duties while he/she attends English for academic training. This training is fulltime 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 kavel to and from English for Academic Purposes training (Bali/Jakarta)
t0 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 Auskalian lmmigration requirement to
receive a student visa
to select a field of study and level of study appropriate to the agency's 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.
Applicant's Level of position
in organisation structure
(eg. Echelon and Golongan)
How long have you known the applicant and
in what capacity?
Please make any additional comments about
the applicant's potential or personal qualities
which you feelwould be helpfulto the ADS
Selection Team.
Ministrv/Aqencv Representative signature*
0n behalf of the ministry, I the undersigned, agree to be bound to the above commitments and strateqies
Authorisation
AusAlD 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 AusAlD, 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 Auskalia Award
to monitor my academic performance at my host university while studying under an Aushalian Development
Scholarships
to brief relevant Australian officials, Ministers and members of Parliament.
Should I receive an Australia Award, I consent to the Aushalian 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 AusAlD's offshore Posts and Australian universities, concerning
the Australian Development Scholarships.
I authorise AusAlD 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:
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r
I have read and complied with the Scholarships Handbook and that the contents of my application are true and
correct
AusAlD 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 Drocess will be entered into.
Agreement
lf successful in gaining an Australia Development Scholarships, I agree that I will:
.
r
r
.
.
undergo a police or character check before my Australia Development Scholarships is confirmed
immediately provide AusAlD 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 Scholarshios.
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
acknowfedge that giving false or misleading information is a serious offence under the Criminal Code Act 1995
of the Commonwealth of Australia.
28
Endorsement by the Government of Indonesia
( To be completed by Head, Bureau of Technical Cooperation, Ministry of State Secretariat
of the Republic of lndonesia
0n behalf of the Government of Indonesia, I certify that I have examined the documents attached to this form ano am
satisfied 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 appropriate
and in accordance with the Government's training policy.
I
endorse the applicant for an Australian Development Scholarship.
Name of certifying officer
Title
Organisation
Official Stamp
Signature
Date
tt
)