Personal details Contact details Proposed study

Australia Awards Scholarships Application 2017 Intake – Additional information for online application OASIS

1. Personal details

Details given in this section must match your passport, birth certificate or other official identification documents. Note: If you have only one name, enter it in both fields. Denotes mandatory field Attach a recent passport size photo. 3 x 4 cm. Title Mr Mrs Ms Miss Dr Other Please specify Family name Given names Date of birth ddmmyyyy Gender Male Female Place of birth Stateprovince Country of citizenship Note: You must be a citizen of one of the eligible participating countries.

2. Contact details

Business address Provide details only if different from your current business address Address line 1 Address line 2 Address line 3 TownCity Postal code if any StateProvince Country Phone Provide your business one contact number. Work phone no. Fax no. if any 9 Are you applying for an Australia Awards Scholarships as a public or open applicant? Denotes mandatory field Public If “Public”, please indicate if your application is from: Government department State-owned enterprise State university Open If “Open”, please indicate if your application is from: Private university Private organisation Private individual

4. Proposed study

DFAT will consider offering you a scholarship only if your course of study will contribute to the development needs of your country. Note that the proposed program of study should be appropriate to your academic qualification and work experience. Denotes mandatory field Requested Level of study Masters Doctorate PhD Type of study Masters coursework program can contain a research project up to 30 of the Masters. Candidate decide the topic during course Coursework Research Combination Research background of DoctoratePhD 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 No Proposed 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. Denotes mandatory field Priority Development Areas PDA Effective economic institutions and infrastructure Human development for a productive and healthy society An inclusive society through effective governance Description of PDA Supporting Indonesia to boost inclusive growth and productive jobs by improving policy and regulatory settings and incentives for investment in infrastructure, particularly from the private sector Improving the productivity and mobility of Indonesia’s labour force through systemic change to provide better quality health and education services to local communities. Support for improved law and justice sector outcomes, local government strengthening, women’s empowerment and access for people with disabilities to public services and social assistance. 10 Other, please specify: Have you obtained information from the Australia Awards Scholarships Information CD, or from the Australia Awards Scholarships website regarding study options in Australia? Yes No Please describe the efforts you have undertaken so far to obtain information on your study options in Australia. 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 Yes No Are there any special subjects or skills that you would like to include in your choice? Yes No If Yes please give details. Note that Australia Awards Scholarships does not include the practical training period required for professional registration, e.g. medical internship, legal articles etc. Applicants are expected to complete such practical training in their own country. 11 List qualifications whether complete or not by level of study, starting with the highest. If you have not completed your studies please list your anticipated end date. One certified copy of any complete or incomplete official transcripts, certificates and certified copies of English Language translations must be included with each application form. Any documents not in English must be translated. Add an extra page if there is insufficient space. Denotes mandatory field 1. Qualification name Level of study Secondary High School Vocationaltechnical Undergraduate Postgraduate S2 or S3 Name of institution StateProvince Country Language of instruction Start date GPA if applicable Obtained Max End date Status Complete Pending results Incomplete 2. Qualification name Level of study Secondary High School Vocationaltechnical Undergraduate Postgraduate S2 or S3 Name of institution StateProvince Country Language of instruction Start date GPA if applicable Obtained Max End date Status Complete Pending results Incomplete 3. Qualification name Level of study Secondary High School Vocationaltechnical Undergraduate Postgraduate S2 or S3 Name of institution StateProvince Country Language of instruction Start date GPA if applicable Obtained Max End date Status Complete Pending results Incomplete 12 Do you identify as having a disability? Under Australian law, disability includes physical, intellectual, psychiatric, sensory, neurological, learning disabilities, physical disfigurement, and the presence in the body of disease-causing organisms Yes No DFAT strongly encourages applications from people with disability who are otherwise eligible for a scholarship. Under the Disability Discrimination Act, Australian education institutions have to provide reasonable adjustments to students with disability to assist access to study. To assess the likely support needs, appropriate assistance, and the capacity of relevant institutions to provide the assistance, awardees with a disabilityspecial need must provide details of the disability andor special need when they accept their offer. This information is bound by Australian privacy laws and will be disclosed only for the purpose of facilitating an accessible barrier-free learning environment. Modifications to physical or learning environments, including additional educational supports such as sign interpreters and captioning, may be available depending on the relevant Institutions capacity. DFAT will advise the Institution of any special requirements associated with an Awardee so that the Institution can pass these details to the Institution’s Disability Liaison Officer prior to the Awardee arriving on-campus. Where an Institution is not able to provide the assistance requested, other Institutions may be recommended. If yes, please provide details if you require special assistance or equipment to participate in the scholarship selection processes or to live and undertake studies in Australia?

7. Communication