ACU International Student Scholarship

HIGHER DEGREE APPLICATION FORM

To be considered for scholarship, applicants must submit a completed higher degree scholarship
application form together with all the required supporting documents by 31 March 2014 to the ACU
Graduate Research office in Melbourne at Locked Bag 4115, Fitzroy 3065, Victoria.
Applicants for the ACU ISS will only be considered if they have also been offered a higher degree
candidature.
NB: The following form is for scholarship applications only.

The ISS provides one international postgraduate research candidate with tuition fees for study
in either a PhD or Masters program. ACU also awards the successful ISS recipient with a living
allowance (2014 rates: $27,000 annually). Selection is based on academic merit and research
experience.

Are you currently receiving a postgraduate award? Choose an item

Have you previously received a postgraduate award? Choose an item

Graduate Research
Australian Catholic University Limited ABN 15 050 192 660

VIC.Cand@acu.edu.au
Locked Bag 4115
Fitzroy Victoria 3065
Telephone 03 9953 3156
Facsimile 03 9953 3315

CRICOS registered provider: 00004G, 00112C, 00873F, 00885B

(A) PERSONAL DETAILS
Title: Choose an item
First Name:
Surname:
Date of Birth:
Gender: Choose an item
Postal Address:
Residential Address:
Phone (BH):
Mobile:
Email Address:
ACU Student Number (if applicable):
Country of Citizenship:
Other residencies:

(B) CANDIDATURE
Name of Course: Choose an item
Enrolment Status: Choose an item
Course Commencement Date:
Faculty: Choose an item
Supervisor (if enrolled):
Co-Supervisor (if enrolled):

Thesis Topic:

Summary of Research Intentions (limit 1,000 characters):

(C) QUALIFICATIONS

Page | 2
 Research
Degree Institution Length Start End Grade
Component%

(D) RESEARCH EXPERIENCE

List any articles or chapters you have had accepted or published in refereed journals or academic
books (including authors, publish date, title, journal or book, pages):

Author/s Year Title Journal/Book Pages

(D) Research Experience continued

Author/s Year Title Journal/Book Pages

List any conferences you have presented at and conference proceedings your work has been
published in:

Conference
Author/s Year Title Location
proceedings

Page | 3


Briefly describe any research experience you have completed as part of your tertiary studies (limit
1,000 characters):

Briefly describe any research experience you have gained via employment (limit 1,000 characters):

(E) EMPLOYMENT

Employer Name Start End Role Description (limit 500 characters)

Employer Name Start End Role Description (limit 500 characters)

Employer Name Start End Role Description (limit 500 characters)

Page | 4


(F) REFERENCES
NB: If you are an existing higher research degree candidate at ACU National, you may request that your original referee
reports be sourced from your student file and used to support your application for scholarship. To arrange this, contact the
Graduate Research Studies Office in your state.
If you are submitting an application for research candidature at the same time as an application for scholarship, please ensure
your referees are aware their written reports will be used in support of both.
It is the applicants responsibility to forward the referee report forms to their nominated referees.

First Referee: Second Referee:

Title: Choose an item Title: Choose an item
Name: Name:
Position: Position:
Department: Department:
Institution: Institution:
Address: Address:
Country: Country:
Postcode: Postcode:
Email: Email:
Phone: Phone:
Fax: Fax:

Page | 5
 SUPPORT DOCUMENTATION CHECKLIST
NB: Official certification of original documentation is compulsory. Certification can be obtained by providing the original
copy and a photocopy to an appropriate authority for endorsement, ie: Justice of the Peace, solicitor, pharmacist, medical
practitioner or the ACU Graduate Research Studies Officer in your state.

Certified copy of birth or citizenship certificate (Australian citizens) or relevant pages of

passport showing residency status or nationality (permanent residents and international
applicants);

Certified copy of transcripts of all tertiary courses and subjects attempted to date.
Transcripts must be in English or certified copies of translations must be attached along
with the original language documents.

Proof of completed research (ie: conference proceedings, published refereed articles,

research reports and theses);

Certified copy of IELTS English proficiency test results (international applicants only);

Confidential Referee Report Form sent to two nominated referees.

Please note: it is the applicants responsibility to supply all support documentation relevant to their application. With
the exception of confidential referee reports, the Graduate Research Studies office is unable to retrieve documents
that have been submitted with previous scholarships or research candidature applications.
Incomplete and/or late applications will not be considered.

(G) DECLARATION
I declare that the information I have supplied in this form, is, to the best of my knowledge and belief,
complete and correct in every particular.
I understand that the giving of false or incomplete information may lead to a refusal of my application
or cancellation of my scholarship at any stage during my studies.
I authorise Australian Catholic University to obtain from other educational institutions and relevant
authorities at any time, details of my enrolment, academic record, examination results and bond
status, including enrolment variations, attendance and addresses during the year in connection with
my application.
I also authorise Australian Catholic University to request and obtain further information from any
employer who may be required to confirm or clarify my suitability and eligibility for this application.
I accept that the application and supporting documentation become the property of Australian
Catholic University and are not returnable.
I agree to abide by the Institutions relevant degree regulations, conditions of enrolment and
postgraduate awards as amended from time to time.
Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth)

Signature: _______________________________________________________________________

Name: _______________________________ Date:

Witness: ______________________________________________________________________

Name: _______________________________ Date:

PRIVACY STATEMENT:
Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal
information collected by the University will only be disclosed to third parties with the written consent of the person
concerned, unless otherwise prescribed by law. For further information, please see the Universitys Statement on Privacy
http://www.acu.edu.au/privacy_policy.cfm

Page | 6