Beasiswa australia agustus

Program

a CJ tr CJ F. r-a {rl -l d

U

a 0.) hA tr4J 3l tw A F{ 0

.-

_F l|hl F"t A_\J t-tsd () V)

F

A \r/

z

v n

*\trstralia

n

Govern

rnen

t

Aid

GEi\ERAL

IhIFORVTATION NOTES

Australian De:,'ciopnrent Scholarships (ADS) provide op" -^tunities for Indonesians to study in Ar"rstralia at POSTGRADUATE level.

Up to thlee hundred and

fifty

scholarships are expected to be awarded

in

2011

for

commencement

in 20lll2Al,2.

Candidates rrrust undertake

shrdy in one of the four ai3as of development priority (see page ii,).

ADS are offered in fwo main categories: 'Public Scctor Category'and 'Open Category'.

Public

sector

applicants

are

employes5

from

Govemment organizations, state universities and state owned enterprises. Their applications

must

be

approved

by

training

or

foreign

cooperation

btrreaus

(BI(L}{)

of

their local

or

central agencies before being

submitted to the ADS Prograur Office. Pubiic sector candidates fiorn sovemment agencies outside Jakarta may apply directly

to

the ADS

Program

Office

r,vith

the

approval

of

their

relevant

Kakanwil

or Kadinas. Cslon Pegatvai i\{egeri

Sipil

are not eligible to apply.

Open

Category

applicants

are from

private

organisations ancl

turiversities and this category is also open to recent trniversity graduates.

No

prior Govemment approval is required

for

people applying

in

the Open Category, and applications are

to

be submitted directly

to

the

ADS Program Office. They require, where relevant, the endorsement of

the agetrcy, instirr-rtion or private universify in r,vhich the applicant is

wor,<ing

or

studying. Applications al'e submitted directly

to

the ADS Office.

Public servunts (Pegawoi i{egeri) crutrtot upply in tlrc Cpen cotegoryt. A thtrd category (Targeted) exists tbr candiclates who are identifiecl bv their organisaiions in consultation r,vitir rhe ADS Progi'am. CanCici:ites

r,vithin this category rnust be identif,red by their home organization nld must not apply to the ADS Program independently of their enipioyer. 'Targeted Category' candidates are ernployed by organisations which are identit-red by the Covernment of Indonesia and Governrnent

of

Austratia (through r\usAID) as being strategically aligned r,vith the

Development priorities of the Governrnent of Indonesia.

Scholarships are for fi-rll-time sfLrdy for a Vlasters or Doctorate degree

fion

ALrsralian tertiary institutions. The scholarship provides up to

nine months tull-time language and academic preparation in Indonesia.

Srrrdepts must achieve satisfactory results in this training to be able to

continue their scholarships.

Apptications from people with disabitities or from people in organisations working with the disabled are encouraged to apply. Wotnen and candidates in provinces within the geographic focus of

AUsAID's Country Strategy (see page ii) are also encouraged to appiy.

ELIGItsILITY

IN

GENERAL CANDIDATES MUST:

t

be an Indonesian citizen and not have permanent residence in Australia or Nerv Zealand.

I

not be mamied or engaged to a person who is eligible to hold Australian or New Zealand citizenship or perrnanent residence '

I

satis$r Australian Government requirements for international shrdent enhy to Australia (health, character etc)

I

not hold a scholarship that would give similar benefits

t

not have held an Ar.rstralian Govemment Scholarship in the l2 months preceding the application

I

be applying to commence a new course of shrdy and not be seeking support tluough ADS for a course already commenced in Australia.

t

be able to take up the scholarship in the year for which it is offeled

f,

satisly the admission requirements of the Australian tertiary institution in which the course is to be undertaken.

SPECII{C

AT,LY.

CANDIDATES

N,TUST:

!

be applying for cotrses that fall within the areas ofdevelopment priority (see next page)

I

at the time of application, be no more than 42 years of age

I

have a Grade Point Average (GPA) of at least 2.9 on a scale of maximum 4.0 (or 2.75 for applicants ti.orn geographic foclrs of ALTsAID Country Strategy only, see page

ii)

and an English language proficiency ofat least 5.0 in IELTS (or 500 in Instirutional/paper-basecl TOEFL or 39 in Internet based TOEFL). The IELTS or TOEFL result must be cunent (a test result obtained in 2009 or 2010

wilt

be considerecl

curreut). Contact details of test centle must be provided for veriftcation of TOEFL test results.

Aplikasi ADS yang ,nenyertflkttrt 'tTOEFL pretlictiott test" dianggap tirktk nrcnrcnuhi persyaratan dfifl secsra otomutis gugur

I

already hold an undergladuate degree, ifapplying for a iVlastels

I

already have a lVfasters, if applying for a Doctorate

I

apply for a degree at a level higher than their.curent highest qualitication

I

ilapplying

for a Doctot'ate, applicants

will

be _{lestlicted to staffofuniversities, higher education institutions, research institltes, key policy}

utaliets and targeted candidates in other agcncics associated wittrAusAID activities

it is ltighly desirable

lirl

Doctontte applicirnts to have a letter of supl,rolt fitrm an Australian univcrsity lrtsrvcl ull re lcvant qrrestions ou thL' itpplicittitin firnrr

l'.l.''ijli:r:.'''lrt|ltr,lti|:t|-|ctttttill.-':',:ii..:l]rlI..:l';.-'i.rlllt1r|:t!.trt.idl1;.0l],()0lrrr-l(r'()(),.,,', iitr.,t;-' r :irt 1,, il,;,j!1tg i,1 r. ; , ,r, i1 .,,, ;,:rt r.;,l,irrrl ir.:i.titr

fil

,f,

'€l

CHOOSN.{GACOURSE,OFSTUDY

which fall within

AusAID's

prioriry

development areas

(PDA)'

The PDA

the Atrstralia and Indonesia Country Strategy.

An

indicative

list of

the areas

shrdy courses

contained in candidates are etlcouraged

to

apply

to

relate

directly to

the strategic objectives

for

studY follows.

ffi6,

_and Peace

nvestitlg in PeoPle

@sticeand

Good Governance

i

ffitnand

Econotnic Nlanagement

ffiIiaTndonesia

PartnershiP (AIP)

PrioritY DeveloPment

Areas (PDA) _{Better quali4', access} ancl _I t,o'p'utlLtIE; tc'>v'r'ovL

governance in edttcation, ancl

I

ltu'no*itar.ian n::dt' better health access

anc{

|

u'"'gencies and

systems vrtlnerability to clisasters, ancl

intprovirtg caqacitY to ensure

transport securitY and ta counter threats from transnational u'ime. Tmproving res7onses to accountabilitY ancl

res pons iveness of legal,

clemocrattc and overs ight instihrtions, and imProving local governnxent and Public

financial management'

WngthecaPacitY,

,.

I mprovitxg econofttlc Po ttcY

anc{ management, reduci'ng constraints to grot+'th in irtfi'astrztcture and pro ductivi t,v, and imProv irtg

natw'al res ource management,

er:i r a nment al governanc e

and respot't;J lc cltmate

change

ilescr-pmn

of PDA

-l-e o mmunicab [e D t s e as e

Prevention

il

Health fuIanagement

il

Health Services

il

lvlaternat and Chitd Health

fl

Wornen and Gender Studies

s

DisabilirY Services

E

Public Health

fl

Educatiou and Training

E

Educationivlanagement

il

Human Resource

DeveloPment

s

Childhood SPecial E'ducation Ivlanagement

t

Agrictrlnrre

I

Aquaculnrre /fisheries

il

Forestqt

il

Ctimat,: Change

t

Economics

E

lnfi'astrucfure Planning

I

Water and Sanitation

g

Rural Growth

F

Srnatl and Mediurn

EnterPrise Develo Pment

SYstems

n

Potitical Science and

Govemment

H

Public Adminisffation

fl

Public ExPendifure lvlanagement

E

P'-rblic Sector Reform

fl

Environmental Law

I

Anti-comrPtion

fl

Decenffalisation

r

Nanrral Resource

@uciiciai

FartnershiP

PrioritY Fielcls of StudY

ffionesia

onTlict nesoiution

Disaster Pre'rentiou and

IVlanagement

Transport SafetY

Transnaticnal Crime

Prevrntion

Dev+[opment Studies

International Srudies

in

their own country'

it-!*fJ]*t)":*?I,":??,

*

independent

l::ll-t:i::ll":"::.Ttn'e

comprised

or

Austrarian and

Indonesian academics

only

those shodristed

r"iiiu" iot"rvi"*"i.

The interview

will

assess

"unJiaur"t'academic

abitity'

clarity

of

study goals' cultural

adaptability.

A

criticar

"ooria"rutioo

wi'

be

n",

.'ar

the

ADS

appticant is

able

to

explain the

rJevance of their

proposed

studl

area to the deveropmenr of Indonesia. The interview

will

be

u..o*puni"Jbf

an

''LTS

test of Engrish language

proficiency'

Finar selection

is objective

and based on

tt"

prin.ipres

of

merit

and;;rlty.'il;

final list of

awardees

is subjectto scrutiny

ant

endorsement by

AusAiD

and State Secretariat'

SELECTTON QUOTAS:

In

the 2010/2011

ADS

cycle, up to tfuee hundred and f,rfty (350)

ADS

schorarships are availabre

for

commencement

in

20lll20r2

The scholarships are allocated as

follows:

;

28

of

aLl awards

will

be offered

in

the

'Public

Sectoc category

;

iE

or"[

awards

will

be offered in tl,e

'open'

category

,-^ronanr

I

up to 50 percent

of

uwu'a' will

be offered in the Targeted Sector Category

r

up to 30 percent

"i

"il

,.f."f *siiips will

be awarCed

L

fine

with

giqgiphi"

fgcus _{9*f lhe Country} Program Strategy'

(The

geographic focus

witt

inctude East-Nuts;a

T"'nggo'o'

lV"'t'iiii

f"nggara''Vapua'

West Papua' and

Aceh)

:

r

90 percent or

u*urJ,

ar Masters

r"u"r

t:

iil

unJ 10 ie-rcent ut

no"torut"

g[i;

teu"t 135).

(NB

doctoral level study is

only

open to

staffofuniversities,

higher education

instit'tions,

research instit*te, key

policy

makers and targeted candidates

in

other organizations associated

with AusAID

activities.

up

to

,"u*lil

prtl

u*u.d,

*-itt u"

made available to

eligible

candidates

within

the Targeted Category

I

an equal number

of

awards

will

be offered to men and women'

Xfl;t$::ffiltT:"ffiffi*""J:'T^"?n#:&1,.:l:::"1ror

an

interview Atl

interviewed appricants

will

be

notin

whether or not they have been awarded un

eni.

ihe

resurt is

final

ond no correspondence

will

be entered

into' where

appropria

notifrcation

wi'

incrude detaits

of

pr.-'"p"**

tr"i"iig^

@nglis[,

academic

ski''s, cultural

preparation)'

This

training

compulsory and

futl-time

(see page iv

for stip

by step

of

ADS

Application

Process)'

g

REQUIRE1VIENTS

FOR

SCIIOLARSHIP RECIPIENTS

Prior

to

traveling

to

Australia,

scholarship recipients must:

r

meet the

minimum English

language requirement

of

their

chosen

Australian universily (usually IELTS

of

6.5

with

no band less than 6.0)

I

at the completion of EAP training, candidates must achieve a minimum score

of IELTS

6.0

for ADS otfice

to cornrnence the

application process for placement

in

a university program in Australia

I

receive a letter ofacceptance from an Australian university

I

meet Australian immigration requirernents for a student visa

g

receive Govemrnent

of

Indonesia

endorsement

I

f

not be pregnant when travelling to Australia to begin shrdy.

qj

f.{

() F{ H *r)

14 ,d

U

qj b's

F

A Frt

q)

.Fl a '*f

u

L

rF t, F. H

e)

a

F

A\

L/

z

\r/ A lrl

}VI{AT

DO

AUSTRdLIAI{

DEVELOPMENT

SCHOLARSHIPS

COIIER?

r

Fees

-

payment of academic fees and any other fees compulsory

for

intemational students.

I

Editofial/tutorisl

ctssi.ttance - provided where

it

is deerned essential to assist arvaidees tc pass corirse subjects.

E

Trcryel

-

payment

of

an economy airfare

tlom

the

principal

international

airyorts

in

Indonesia (Jakarta

cr

Denp.rsar)

to

the

majof airyort

nearest the Australian

universiry

and

retum

travel to Indonesia.

A

seperate reunion airt'are r.vill be available to

the sftrdent after the successful completion

of

the

first

year

of

sfudy; s',r!-rsequent reunion airfare entitlements

will

be available on an annual basis

for

the duration

of

the

ADS,

except for the

final

year of the ADS.

!l

Overseas

fieldwork

-

holders

of

a scholarsirip r,r,here researcir courprises

at

least 50 percent

of

the pr:ogratn

lnay

receive a retum airfare to lndonesia to undedake essentiai fieidrvork.

ll

Fantily entty -

arvardees can bring their immediate families to Australia, at their own cost,

if

their

farnilies meet

AusAiD

and

immigration

requiremeuts.

t

Livin.g allou,ance - payment of a contribution to

living

allorvance.

!

Overseas Student

Health cover (OSHC)

-

awardee

only

(arvardees are required

to

maintain OSHC

for

any

accompanying

family

in order to satisSr visa requirements).

I

Provision

of

an

AusAID

Student Visa.

FANIII,Y

ENTRY

Awardees can bring their immediate families to Australia at their own cost,

if

their

farnilies meet

AusAID

and irnmigration requirements. Families are

nomally

permitted to

join

eight (8) weeks after the arvardee's arrival.

In

Austrulia,

scholarship recipients must:

ll

abide by the conditions of the scholarship and the rules of Australian

tertiary

H

abide by the rules and reglllations governing a student visa

E

act

in

a \Nay that

will

not bring disreptrte to

AusAID,

or to any Australian

E

rerurn irome at the end

of

the a\,vard period..

COMPI-ET{NG THIS FORM

The application

fonn

mlrst be completed

in

English.

Alt

required

documents must be provided (see page 15).

Alt

relevant sections

of

the

form

rnust be completed.

Before applying,

all Public

sector applicants are required to have

section

l4b

of

the form

completed

by

the relevant training

or

foreign

cooperation bureau

or

their

u.niversity rector (whichever

is

appticablel.

Applicanis in

the Open category are not required to

fill

in

section

14b.

Their

applications are

to

be srlbmitted

directly to

the ADS

Office

at the address below.

in5titutions

"s

insrifirtion or to Indonesia

Applicants must not

fill

in

section L4d.

This

section is

for

State Secretariat use and refers

onlv

to selected carldidates.

Applicstions

nrust

be

received hy

the closing

date

of

27

Augrlst 2010

at:

ADS

OFFICE

Gedung

\,ry'irausaha,

2ns F

lcor

Jl.

H.R.R.asuna

Said

Kav.

C-5

Step

1

Applicant

sends

complete

AnS

application forrn

to

ADS Oftice by

27

August

2010.

The ADS

Apptication

Process

Step

5

Applicant

is advised

of

the result

of their ADS

application by

February

2011.

Step

2

Appticant

is

notified

of

the

result of

setection

for

interview by

Secennber 2010.

r

I

:

rl i:

I ii

Step

3

Applicant

selected

for

interview

receives

information of

intervied

IELTS

test dateilocation.

Step

4

Applicant

attends

intenriew

and

IELTS

test

in January 20L1.

Australian

Government

t; I

1.

Applicant

Details

Aftach

a

recent

passport

size

photo.

3x4cm.

ivlale

n

Fernale

n

Country

Code

Areacoce

I

Email

Title:

Mr

n

ivlrs

n tvrt[

Dr

n

-'

Given Name (as shor.vn in

Birth

Certificate)

Family Names (as shown in

Birth

Certificate)

Othcr l.lame

(if

applicable)

Your

date of

birth

Your

country

of

citizenship

(day/month/vear)

hlIP

for Public

Sector APPlicant

Address

for

Correspondence

The

scholarship

application

takes several months

to

be finalised.

Piease

give

an address where

you

can

be

contacted rvhetr

decision

is

reached.

It

is very important

to

give the email

address

and

handphone

nurnber

lvhere

we

tan

contact

yo

you will

not receive a scholarship

if

the

Austrrlian

Agency tbr International Development

(AusAID)

cannct contact you.

Handphone

Flo.

Current lfome

Adtlress

Number and Street (or: Post Box lrtrumber)

Suburb or

Town

StateProvince

Cotrntry, Postcode

Telephone Numbers (lvhere yott can be contacted)

Phone

lriumber

Fax

Number

Current

lYork

Address

I.{urnber and Street (or Post Box Nurnber)

Suburb or

Town

StateProvince

Country, Postcode

Tetephone lrtrurnbers (r,vhere

yolt

can be contacted)

Phone Nutnber Fax Number

Will

they

b. joining

you during your period

of

study in AustSalia ?

Provide details

of

any

family

members who might

join

you In Australia:

2.

Dependants

If

you

have

any

dependants please

Do

you have a husband or

wife

?

Do you have any children ?

If

you

answered 'fhl'o''

to

both of

If

you

answered

"Yes" to

any

of

the

Are

they already

in Australia

?

answer the

following

questions:

the

above,

please

go

to

Section

3. above, please answer

the following:

a disabilify-focused organisation? meCical assessment

if

relevant.

T::

E

;::

E

Yes

I

hio I.lo

No hlo

llo

Given Name

If

"Yes", please

give

details and affach any

4.

Under

Which

Category

are

you

applylng for

an

ADS

?

Open tr tt

_application

,'Open',

please indicate

if your

Public

I f

'Public',

please

indicate

if

your

application

is

is

from:

-

from:

Private

Universify

Private

Individual

n

n

Government

Department

t]

State-owned

Enterprise

n

State

Universiry

t]

If

'Public',

pleaqe also

tick

here

if

you are:

Pi{S

I

Non-PNS but

working for

GoI

5.

Interview

Centre

Please

tick

your preferred interview center. (Please note

Your

choice is not guaranteed.)

n

n

l

n

1. Jakarta

2.

Yogyakana

3. Surabaya

4. Denpasar

u

u

u

n

5. Medan

6. Padang

7. Balikpapan

B. Jayapura

9.

Makassar t]

10.

Manado n

11.

Kupang n

NB. Intentiews in Jayapura are subject to GoI approval and an alternative location mqy be proposed.

Spouse

Children

* _{Pleasefill the gender box with "M"}

for

Male and "F"

for

Female.

3.

Disabilify

Awardees

with

disabilities are encourage to apply

for

an

ADS.

If

you do have a

disability,

the provision of details on disability

wiit

enable appropriate measures to be put in place

in

the

ADS

Program.

Do

you have a

disability

or do you

work

in

Gender*

n

t:]

ll

H

[:

6.

Academic

Qualification

Completed

qualification:

please provide

postgraduate

training

and qualifications.

Applicants

are required to

filI

out the total

Educational

Institution

Faculty

the following

infonnation

for all

completed vocational,

technical, undergraduate r

GPA obtained and the maximum GPA possible for each qualification noted below.

Country

Years

attended Qualification

obtained

&

GPA

From

To

maior

fields

Obtain

Ma,r

n

I

n

T

T

n

Three

certified

copies

of

official

transcripts and certificates

MUST

be included

with this

application.

If

you

are

selected

fi

interview,

you

MUST

provide cer-tified English translations

when

you attend the intervierv.

Previous

Applications,

Scholarships

or

Acadennic

Awards.

Flave you previously applied for an ADS but were unsuccessftil?

If

"Yes"

how many times have you applied for ADS? (NOT includtng this

application)

Have yotr previously been interviewed by ADS?

If

"Yes"

When?

What was the year of your last applicaton?

Have you

previously

received any other scholarships or academic awards?

If

"Yes"

please

give

details: (Name

of

nvards,

Level

of

study, and Year attended)

Current

Studies.

If

you are

currently

studying

please

provide

Country

in

which

srudies are taking place

Ir{ame

of

Instihrtior/S choo I

the

follorving

information.

t

TI

TI

TI

Yes

il

Yes

IrIO

i

No

Yes

il

l{o

r__

t

Name

of

awards

Level

of

Studv

attended

Level

of

Study

Name

of

Course

Post Graduat*

I

Other

n

specify:

What

qualification

do you expect to gain at the end

of

these current studies ?

When do you eKpect to complete your cuffent studies ? (doy/month/year,

If

not completing

your

course this year, how many years have you completed ?

When

will

results be available ? (day/month/)tear,

7.

trnglish

Language

Proficiency

Was English the langlrage

of

your secondory school

If

"Yes"

provide

a

statement

from the

institution

Have you undertaken an

IELTS

or

TOEFL

test ?

or terliary shrdy ?

veriffing

the

language instruction.

u

n

(clay/rnonth/year)

Director Narne: Phone/F{P lr{o.: Website:

Any

other English Langua,-qe test? t

Note:

Applieant must have an English language proJiciency of at least 5.0 in IELTS

(or

500 in Institutional/paper based TOEFL or 39 in Internet baserl TOEFL). The IELTS

or

TOEFL result must be carrent (a test result obtained

in

2009 or 2010

will

be considered current). An original copy

of

yoar IELTS or TOEFL certificate must be attached to the applicationform"

8.

Proposed

Study

Program

Note ttrat the proposed program of study should be appropriate to your academic qualification and

lvork

experience.

Requested level

of study

What post$aduate level

of qualification

do you.,yant to gain

with

this scholarship ?

You will

not

be

allowed

to

upgrade

your

course

from

the level at rvhich

you

are

first

placed.

Yes

Yes

I

Irio

Irlo

Results:

IELTS

Nlasters (coursework)

tNB: fufaster colrsewark progr

I

ams can contain a research project ofup to 3A% ofthe Masters. Candidates decide the topic during course)

N{asters (research)

R.eseanch

background of Docforate

candidates

only:

f,

Do you hold a lvlasters degree

with >

5A% weighting for research ?

E

Are

you including

a letter

from

your Masters supervisor recommending

that

you should pursue Doctorate studies ? (Recorunended)

tl

l

n

u

Proposed

field

of study

You

are required to:

I

ldentiff

the

priority

Development Area

@DA)

for your proposed studies (must be the same as you indicated on page

I

of the

application

form)

(Please tick one box only).

I

Identify

the

Priority Field of

Study (PFS)

from

the

list

of preferred PFS provided (Please tick one box only).

I

If

necessary, you may nominate another

Field of

Study in 'other' (Please tick other and

provide

detail).

Yes

Yes

Dcctorate

n

htro

hio

Australia Indonesia Partnership

Priority

Developrnent Areas (PDA)

Sustainable

Growth

and Economic iUanagement

f

Democracy Justice and Good Governance

n

Invesfing in People

n

Safefy and Peace

f

Australia Indonesia Partnership

Priority

Fields

of

Study (PFS)

I

Natural Resource

Managernent

D

egri.ulhrre

f]

Aquaculture /fi sheries

fl

Forestry

I

Cti*ate Change

I

Economics

fl

tnfrasfrucfure P lanning

f]

Water and Sanitation

fl

Rural Growth

fl

Srnall and lvledium Enterprise Deve lopment

lfl

Law, Legal and Juditial

I

Systems

lfl

Potitical Science and.

I

Gou.rnment

lfl

puutic _{Adminiskarion}

lf]

Puutic Expendirure

I

tvlanagement

lfl

PuUtic Sector Reform

lf]

Environmental Law

lfl

anti-comrption

lfl

o.t.ntralisation

I

I

lfl

Coriiffi

I

Pr"rrention

lfl

geatth Management

l[

Heatth Services

lfl

Vtut"rnal and Chitd

I

Health

l[

Wotoen and Gender

I

stuoies

lfl

Disabiliry Services

l;

euutic Health

lfl

Education and Training

l[

EAu"ation lvlanagement

lfl

Hunrn Resource

J

Development

Itr

Cttitdhood Speciat

I

Education

fl

Conflict Resolution

fl

Disaster Prevention and

Ivlanagement

fl

Transport Safety

I

Transnational Crime Prevention

fl

Development Stqdies

fl

International Srudies

IOUt

er, Please specfy;

Please explain the particular focus

within

your identified proposed Field

of

Shidy.

Have

you

obtained

Australia?

h t tp : // cr ic o s . cles t. gov. au

t Australian lufitritime College

. Australian Chatolic University

. Carnegie lulellon Universitv

c _{Central Queensland University} . Charles Danvin University

t Charles Sturt University

. Curtin Llniversity af Technologt

t Deakitr University

+ Edith Cowan Lfniversity

i) _Grifith University

a James Cook Universi4,

o La Trobe University

t fu[acQuarie UniversiU

+ Monash University

i

+ Mtu'doch University

. _Queensland (Jnh,ersity of Technologt

. R'VfiT Universiryt

. Sottthern Cross (Jniversity

. Swinburne Universig of Technologlt

e The Australian National Universi4'

o The F[inders (Jniversity af South Australta

r The Universtty of Ac{elaide

o Tlrc University of lvfelbourne

t The {iniversity of Queen.sland

+ The UniversiS of Sydney

, ) The Universitl'' of Westet'n ,lustralia

t University of Ballarat

. {.lniversity of Canberra

. [Jniversity oJ'Newcastie

r (Jniversity of New England

. {Jniversity of llew South Wales

o (Jniversity o1 South Australia

<f Universitl' ofsauthern Qtteenslancl

6 Unh'ersity of Tasmania

c (Jniversity of Technolog,, Sydney

. {Jniverstty of the Sunshine Coast

o (Jniversiql' of Western Sydney

. University of Wollongong

. Victoria {intversity

. Boncl UniversiU

r The {Jniversiv of Notre Dame '4ustralia

shrdy options

ln

lt{o

institution?

This

is

No

tl

made

preliminary

information

frorn

the

ADS

Information

CD

ROIVI,

or from the ADS

website

regarding

Yes

f]

please describe the efforts you have rindertaken so far to obtain information on your study options in

Australia'

Research candidates

only

Please insert

four

(a) key words regarding your proposed research.

1)

'Z)

rt

n)

ADS

Institutions

List

Following Australian instituiions

ale

under contract

to

AusAID

to

provide

courses

for

ADS

awalCees'

Awardees

are

required

to find

a

suitable course

of

study at

one

of

these

institutions. PhD

candidates

must

fi[d

a

supervisor

at

one

of

these

institutions.

please

visit

ihe

following

website

for

more details

on

Australtan

Edr.tcational

Institution:: und

courses

-

cRICoS:

Have you

discussed

yolrr

proposed

course

with a

member

of

staff

from

highly

recolnmended

for

PhD applicants.

A

formal offer

of

admission

will

not

be

enqlliries to possible institutions regarding

any Australian

LlniversiLvir

Yes

n

required however

it

is

expected serioLts

PhD

candidates

will

have

their shrdy. Attach any relevant correspondence

with

institutions.

Name

of

Staff

iVlember ir{ame

of

trnstitution

and

Faculfy

Are there any special subjects or

skills

development that you would

like

to include in your choice ?

rr{o

t]

Yes

If

"Yes" please give details. (irlote that

ADS

does not include the practical training period required

for

pro feis ional registration,

es. medical internshiP, le 1 articles etc.

A

licants are expected to complete sllch ractical trainrn in their own country).

I

If

you

are

applying

undertake

fieldwork

If

"Yes", please give

for

a

postgraduate course

of

study

which

includes

during this course

of

studY ?

details.

more than

50

percent research,

would you

expect

to

Research

Outline

AllPhDandMastersbyResearchappIicantsprovidedatWyw.gdSindonesia.or.id'(click

on

'Download' merut)' Note that this is

only

u

pt.litinury

*tlinffiur

_{proposed research and that your}

actual research proposal

will

be determined

during

your course

of

sruJy-

in

consultation

with

your

supervisor.

More information

_{on developing a research}

proposal is provided _{at the linkpag e at www.adsintlonesia.or.id}

(ctickln

,Links,

menu).

9.

Employment

Record

9 a,.

Current

Employrnent

(NB

-

You

must provide a cuffent

CV)

Current

position

(If

you are currently

Title

of position held

Curent

employment Dates

Idame

of

emp Loy erl organisation

If

universiry

inclr-:de

faculf

Ph.D

candirlates

only

Please indicate your role position

working,

please answer the

following

question).

From

/

(dayt'nronth/year)

Planner

n

Golongan

Resesrcher

n

Briefly

describe the worlc

of

your organisation _{and the service}

it

_provides.

Briefly

describe

your

f-,ecturer

n

Previons

position:

If

you

have

held any

previotts position

below.

please attach details of

cv

(essential recluirern:ntt)'

RELEVANT to your

proposed

fietd

of

training,

please

give

details

9b.

Future

EmPloYment

what

role

and

responsibilities

do

you

expect to undertake after

your

academic

studies?

t*"*ectfic

t"-*"

l0.EligibilityforanAustralianDevelopmentScholarship

.r

co*ntry

oi

crtizenship ? (As shown*iiryour travei cccur,ient)

In which

country do you

live

perrnanently ?

Yes

Yes

Yes

No

No

No

n

n

n

HaveyouappliedforpermanentresidenceorcitizenshipinAustraliaorNewZea]land,|

Are

you entitled to Australian permanent residence or citizenship status ?

Ercluding

hotiday or other short visits have you been granted temporary residencestatus

in

Australia ?

If

'Yes'VisaNumber

n

n

n

IMPORTAhIT:

Have yoLt hetd an

Australian

Govemment scholarship in the past ?

If

'Yes', please give details

(including

yearls

of

scholarship and qualification received).

NWPORTAl\T

po

you currently

hold

any other scholarship

from

another government or sponsoring group ?

If

'Yes', please give details.

Yes

Yes

n

No

Itio

IYARJYII{G:

In

section

I

l,

12

and

13

you

\,vill be

agreeing to

Failure

to

comply

with

these

conditions

will

rrlearl

scholuship

may be terminated.

Do NoT

sign

the

declaration

at

the

end

of

section

If

you

have

any problems

understanding 'section conditions from the

ADS

Office.

attached

to

your large debt

to

the

.:,,'..

awerd

and

your

shrdy

in

Aus traha.

Government

of

Australia

and your

l4a

until

you

1

1,

12 and

13

fully

understand

the conditions

of

the

scholarship arvard.

you are

strongly advised

to

seek

clarification

of

these

11.

Conditions

of

Scholarship

If

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

yoru infonnation.

In

accepting an

Australian Development

Scholarship, you

will

be asked to:

I

agree

thatthe

scholarship offered is

for

the

appropriate

field and

level

of

study

f

acknowledge that no additional study under the scholarship

will

_{be considered}

r

agree not to change

your

enrolment

without

the

prior

agreement of

AusArD

I

agree to study

fuIl-time

and meet

all

the course requirements as set out by the education

institution

t

agree

not

to

engage

in

employment outside

vacation

periods

without

agreement

from AusAID

and

not

beyond the

restrictions

applying

to your visa

I

acknowledge that the scholarship may be withdrawn by the Australian Government

I

agree to rehtrn home

promptly

upon the completion

of

your

studies

E

"'

agree to'advise

AusAID

irnmeCiaieiy shouid

you

mariJran

Austraiiarror

NeW Zeriiariil'Citizen

oi

appiy

to

Change'your visa

status

I

acknowledge

that an

application

for

permanent residence

in

Australia

will

put

you Australia to the total value of

your

scholarship

I

agree to ensure that the education institution has a current record

of

your residential address

I

agree to disclosure

ofinformation

regarding your progress and

I

agree

to

act

in

such

a

marulet

that

wilt

not bring

disrepute

to

yourself;

AusAID, your institution or your

country

of

citizenship during the award period.

Please

note:

AUsAID

expects

individuals

to

spend

at

least

two

(2)

years

back

in

their

home

country utilising the skills

gained before undertaking a further period

of

long-term study.

Subject to your

fulfilling

these

conditions AusAID

will

provide

the

following, (either directly

or

through the

education

institution):

t

direct payment to your education

institution

of the

full

cost

of

your

tuition

I

payment

of

one (1) return economy airfare from the

principal

international airports in Indonesia (Jakarta or Denpasar) to the

major airpod nearest the Australian university. (The

first

reunion

ailfare

entitlement

will

be available to the student after the successful completion of the

first

year

of

study. Subsequent reunion airfare entitlements

wiil

be available on an annual basis

for

the duration of the ADS, except for the

final

year of the ADS)

I

a once only establishment allowance payment at the commencement of the scholarship in Australia

I

a

contribution

to

living

allowance payment every

two

weeks that is designed to contribute towards

your

living

expenses in Australia, during the course of

your

award

_,i

r

where

appropriate and agreed

in

advance,

u

on."'only

retum

economy class

airfare

to

your

home

counky

to

undertake

required

field work

for your research topic (the

living

allowance

will

be continued for the period of approved

fieldwork);

r

additional

tutorial

assistance

and/or editorial

assistance where

this is

agreed

to

be

necessary

to

assist

your

satisfactory

academic progress

l

health cover

-

for

students (awardees are required

to

maintain OSHC

for

any

accompanying

family

in

order

to

satisfy visa requirement)

I

provision of an

AusAID

Student Vrsa'

Your training institution

rvil! provide

for:

f;

instruciion

and

facilities

necessary to complete the specif,ted course

{appropriateacademicandwelfaresupportforthedurationofyourstudies

q

airport reception and temporary accommodation anangements on

arrival

in Australia'

12.

Frivacy Inforrnation

The

information

given

in

this

application

will

be

used

to

attempt

placement

in

.the .area

of

training

requested'

To

enable placement,

the

Australian goverment

or

its

representative

usually

sinds this

application

form

to

the

institutions

you

havl

nominated.

Details

from

this form

will

be recorded.

Your

own government or employer

witl

be given details about successful and unsuccessful placement.

This inforrration inay

include details about the institutions,

training,

length

of

training,and cost associated

with

the course.

AusAID may

exchange persona,l details

suitability

for

the schotarship and a visa.

AusAID

students and any request by them

and details

of

previous

visits to

Australia

with

immigration authorities

to

determine

AusAID

and Australian

immigration

authorities

will

also exchange

information

about to change visa status.

n

u

rl

u

n

n

Where

did

you

obtain

Your

Please

tick only

one box

1.

-

ADS

lvebsite

2.

ADS office

3.

Colleague / workPlace

4.

Universify

5.

Education agent

6.

AusAID

_Project

office

7

,

Other (Please sPeciff):

apptication

form

from?

flas

the

information provided

to you sufficient to

enable you

to submit your ADS

appLication?

Please

tick

onlY one box

Yes

No

13.

Application

SurveY

\Yhere

did

you

first

hear about ADS

?

Please

tick only

one box

1.

Irtrewspaper article

2.

]r{ewspaperadvertisement

3.

Australia Awards website

4.

Radio KangGuru

5.

Television news prograrn

/

talk shor,v

6.

Radio news

/

talkback

7.

Presentation

/

seminar

8.

Colleague

/

friend

9.

Workplace

10.

University

1

t.

Alurnni /

recipient of a scholarship

from

Australia

12.

ADS

Jakarta

Office

13.

Aushalian ErnbassY

1,4.

Other (Please sPeciSr):

u

u

n

n

u

tl

14.

Authorisation,

Agreement,

Declaration

and

signature

14a.

Applicant's

Declaration

I

certi$r that the

statements made

by

me

in

this application

for

an

Australian

Development Scholarship are

tme,

complete and

conect to the best of my knowledge.

I

fully

understand the conditions under which the scholarship

is

offered, and

if

offered

a

scholarship

I

agree

to:

a)

carry out

such instructions and abide

by

such conditions as may be stipulated

by

both the Australian Government and the

institution

supervising my scholarship and sign an agreement

with

the Australian government to that effect

b)

take up the scholarship in the academic year for which

it

is offered

c)

abide by the rules and regulations governing my student visa

d)

follow

the course of study and abide by the rules

of

institutions in which

I

undertake to study

e)

submit any progr€ss reports

which

may be required

0

act

in

such a manner that

will

not bring disrepute to my5elf,

AusAID, my

instihrtion or my country of citizenship during

my

awaro

g)

return home

at

the end

of

my

scholarship, regardless

of

the

time

remaining

on my

visa,

c.^. s.t

ani' time

upo;

forrnal

request of the Australian Government.

I

also agree:

h)

to

the

release

of

information

contained

in

this

application

form to relevant

authorities

to

enable placement

in

a

tertiarv

institution

and consideration

for

a

scholarship and the _{ongoing adrninistration of my scholarship}

i)

to

undertake any preparatory

English

language

tuition or

other

bridging

program as requirecl by

AusAID

or my

Australia

institution

that the Australian Goverment is not responsible

for

any aspects

of

my action while

I

am in Australia

to the exchange

of infonnation

between

AusAID

and Australian irnmigration

officials.

I

understand

that the

law of

Australia

and

various

States and

Territories

will

apply

to

any

agreement befween

myself

and the

Australian Government.

I

am

not

aware

of

any medical

condition (disability,

illness

or

pregnancy),

which might

_{prevent me}

from

_completing

my

_sfudy program

within

the time allowed for the schoiarship.

I

fully

understand that

if

I

arn granted a scholarship,

it

may be subsequently

withdrawn

if I

fail

to make adequate progress,

or for

other

sufficient

cause determined by the Australian Government or the

institution

at which

I

am enrolled..

i)

k)

Printed name

Signature

tl

(day/month/year)

1"4b.

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

shtdy

-for

example

staff

fi-om

the

International Relations Bureau

(BKLN)

/

Cenhe

for

Education

and

Training

/

the

Planning Bureau

/

Rector

from the

universify

as

appropriate. Applicants

from

outside Jakarta

must

have

the

approval and nomination of their relevant

Kakanwil

or Kadinas')

Please note

that your

signature

on

this

form

signifies

your

agreement to the

following:

I

to

release the applicant

from work

duties

while

he/she attends

English for

academic training.

This training

is

compulsory

|

E

to release the applicant

from work

duties after English

for

academic

haining

to study

in

Australia, and process passport and exit

permit

r

to cover the cost of travel to and from

Engtish

for Academic Putposes training (Bali/Jakarta)

!

to cover the cost of travel to the

point

of departure (BalilJakarta)

prior

to travel to Australia

E

to

cover the cost

of

medical

examinations

for

the

applicant.

A

medical examination

is

an

Australian Immigration

requirement to receive a student visa

I

t'

sei.ect a

field

ot stuciy 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

f

iture

research and lcr teaching responsibilities.

Name

of

Deparlment/Employer Name

of Applicant

Applicant's current position

Please indicate

yolr

emploltment status

1.

How long

have

'you

known

the

applicant and in rvhat capacrty?

PNis

tl

Non-PNTS

tl

full-time

and

their

official

2.

Nominator,

please rate the applicant

in

the areas indicated below.

ADS

is interested

in your

comparison

of

the applicant

with

his

/

her peers and colleagues at the same level (Please tick)

A.

Intellectual

ability

B.

Analytic

frame

of

mind

C.

Problem-solving orientation

D.

Potential

for

promotion

and

career

development

E.

Qualiry of

oral expression

F,,-

:*guglitl€yl$n

g*Pres s i on

G.

Motivation

and energy

H.

Leadership

I.

Organisational

ability

J.

Emotionat

maturity

K.

Abilify

to meet deadlines

L.

Abilify

to

work with

others

M.

Commitment to

public

service

N.

Professional

integrify

','Avgrage-=-.

,(top.50%")l

Gclongan

3.

Please make any

additional

comments

about

the

applicant's

potential

or

personal

qualities

which

you

feel

would

be

helpful

to the Joint Selection Team.

Signafure

1"4c.

NGO

Applicants

Onlv

ptease

rickhere

n

Ir{ame of IrtrGO

Address of I.-IGO

NGO

Year

of

forrnation

i\iGO

key contact person

NGO

website address

NIGO background

/

purpose

NGO

form

of activiry

I{GO

pr"ogram

NGO

funding source

NGO

membership

ID

Den

artmenf/ Agency Renresentative

on

behalf of the department,

I

the undersigned, agree to be bound ro the above commitments anc strategic.s

signrrure & sta-nnp.

ltlarne

: Position :

Mobile#:

Email

:

Date

:

I

agree

to

the

planned

d:parirnent's

strateg;r

for

skills

on my refurn

course

of

study

and

to

the

transfer

cf

knowledge and

signature & stamp.

14d. State

Secretariat

use onlY

Cooperation,

State

Secretariat

of

that

I

lrave

examined

the

documents'

-;'

'

.l.ngth

of

award proposed.

in

this

application

'

the

Republic

of

Indonesia

) attached

to

this form

and

am

'

are

appropriate

Official

Starnp

; ' I - -_ '."at,-

€

15.

Documentary

Evidence

Please

note:

I

Applications

with

incomplete documentation

will NOT

be considered

for

a

scholarship.

I

THREE

SETS

of

the application

form

and documentation are required (photocopy applicatibns are accepted).

I

Each copy of the application

fonn

should have attached

certified*

copies

of

the relevant documents listed below.

*Certified:

_{a statement that the document is a true copy}

(original

sightedllegalisir cap

asll),

signed stamped and dated

by

a magistrate or

equivalent.

I

All

applicants must attach copies

of

a certified

transcript

of

academic

record apd copies

of

their

award/degree.

Copies

of

original

documents are

to

be

cerHfied by

your university

or notaris,

or

by staff

at an

IDP Office

(see

wvw.indonesinidp.com/

en glis h_v er s io n/o ur_h r anc h es. aspx) .

Documentation

(Please

tick if

you have attached the

following

documents

in

support of your application).

CHECK

I-,[ST @ssential)

Have

you

included the

following

docurnents?.

$€

copies

of birth

certificate or equivalent

8€

KTP

or your passport personal information pages

3€

cunent

Curriculum Vitae

3E

off'rcial

(certified)

tertiary

certificates/degrees

3€

official (certified)

tertiary

transcripts

of

results

Per

copy

of applicetton.

,xl

n

xl f

xl n

xl tl

xl I

3€

current

certified IELTS

or

TOEFL

English

language test results (a test result obtained

in

2009

or

2010

considered

curent).

TOEFL prediction

test

is

NOT

accepted

3€

Doctorate applicants must aiso attach certified S

I

degree certificate/transcript

3t

academic reference

from

52 supervisor

forDoctorate

candidates

3E

Doctorate and those Masters applicants whose study

will

include at least

fifty

percent research

must attach an

outline

of the proposed research

project

- see

format

to use at www.adsindonesia.or.id (click

on'Download' ment)

Addifional

Documents

(Optional)

Applicants must provide the

following

docusrents

if

they are selected

for

an interview.

will

be

KI

X1

KI

K1

Per

copy

of applicati

XI

X1 K1 X1 X1 K1 X1

XI

f

u

u

u

n

n

n

u

u

u

u

n

ffi

SE qP

db

ffi

qp

CTD

$t

3€ $€

recent photograph (3

x

a)

offi c iat

(certified)

English translations

of

Indonesian certificatesidegrees

official

(certified)

English translation

of

terti ary transcripts of results references

from

S 1 supervisor

for

Masters candidates

(if

available)

list

of relevant publications, unpublished theses

(for

research applicants)

statement from

university

that English is a language

of

instruction

(if

applicable) relevant correspondence

with

an Australian institution

(if

available).

official

(certified)

English translations

of birth

certificate