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Application SELF ASSESSMENT FORM FOR ELIGIBILITY

No:

YES I. Are you a Pakistani national? 2. Do you have dual nationality? If yes, please provide details

D D

NO

D D D D D

3. Do you have permanent residence in Australia or New Zealand? D 4. Are you married or engaged to a person who is eligible to hold Australian or New Zealand D citizenship or permanent residence? 5. Have you been selected for any other Government or Foreign Scholarship? D If yes, please provide details 6. Have you held any foreign scholarship within the 24 months preceding this application? D (24 months are calculated from the date of arrival back in Pakistan to the closing date for receipt of application, i.e. 8 April 2011) ONLY if you have answered Q.1 "YES" and have answered Q. 2,3,4,5,6 "NO", please contihue

7. Are you applying for a Master level course to study in Australia? 8. Will you be able to take up the scholarship in January 2012? 9. Are you applying for one of the priority sectors listed in the scholarship advertisement? If yes, please include priority sector _ 10. Do you have at least 16 years of education? 11. Do you have at least 2 years of work experience after your 16 years of education? 12. Which Profile are you applying under? _ (Description on Profiles under which you can apply is available on http.z/www.adspakistan.com.pk]. 13. Will you be 45 years or older on 8 April 201 f~ 14. Do you have a current (taken after 31st Jan 2010 IEL TS score?
(For profile 4 Candidates, IEL TS score of 7 with no band less than 6 is a mandatory requirement for application. Profile 1,2 & 3 candidates, may provide if available (lEL TS score of 6.5 with no band less than 6.0)

D D D D D D D D

D D D D D D D D

Please provide overall score

and test date

15. If you are applying for a Masters by research degree, have you attached an outline of the proposed research project (up to 1000 words)? Please proceed with ADS main Application for Q. 13. Form only if you have answered

"YES" for Qs. 7,8,9,10 & 11, and "No"

16. Are you living with a disability or working for people living with disabilities? 17. Gender Attach one copy of this form on top of each set of three application Professional presentation of your application is a requirement forms.

Yes Female

D D

No Male

D D

APPLICANT CERTIFICATION I certify that, to the best of my knowledge and belief, all of the information on or attached to this application is true, correct and complete and made in good faith. I understand that false or fraudulent information on or attached to this application are grounds for disqualification or for terminating the scholarship award once r have begun studies in Australia. I understand that any information I give may be investigated. FULL NAME SIGNATURE DA TE OF BIRTH DATE

A
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lcatio

or

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Please use BLOCK LETTERS and BLACK INK Applicants must complete all 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) original hardcopies (Not photocopies) of this application form along with all attached documentation must be sent by courier to the following address: Australian Development Scholarships Office Level 4, Serena Business Complex, Khayaban e Suharwardy, G-5/1, Islamabad. Please write the profile number, under which you are applying, on the top right corner of your envelope. DO NOT send this application to Universities or TAFEs in Australia.

Photo 1.5 X 1.5

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>
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ADS are offered to Pakistani Candidates whose proposed course of study will contribute to the long term development needs of the country. It is important to choose a course that is a priority sector as ). Course information is Register of Institutions and Courses The courses declared by ADS. A list of the priority sectors of study is available from the ADS Pakistan office in Islamabad or from the website ( http://www.adspakistancom.pk

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ADS website includes a full list of Australian Institutions that accept ADS students. available directly from the Institutions' websites or the Commonwealth for Overseas Students (CRICOS) website (see details below).

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You should choose two preferences of Master level courses offered by Australian Institutions.

may be either at the same Institution or at different Institutions but should come under the same priority sector. IELTS requirement for a course varies with different universities and may be greater than the scholarships requirement given below.

> >

Candidates are encouraged to apply through their current organization; however they can also apply directly. Ensure that each set of 3 applications is presented neatly and professionally on A4 paper, vertically secured together in the following order: a. feedback form; b. self-assessment form; c. three passport sized photos; d. application form; Attested copy of IELTS score sheet (mandatory for profile 4 Candidates, IELTS score of 7 with no band less than 6 .
Profile 1,2 & 3 candidates may provide (if available) an IEL TS score of 6.5 with no band less than 6);

e. f. g. >

attested copies of academic qualifications (all degrees and all transcripts); attested copies of Employment letters specifying years of service and job description (for all years of employment); attested copy of passport or National Identity Card. of A full list of the ADS conditions is contained in Please note that ADS reserves the right to

If your ADS application is successful, you will be required to sign a Contract with the Commonwealth Australia and be bound by conditions of the ADS scholarship. change these conditions at any time without prior notice. the ADS Handbook, available for download on the ADS website.

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Submitting this application does not guarantee that you will receive a scholarship.

THIS DOCUMENT IS NOT FOR SALE

General Eligibility Criteria


Applicants must meet all of the ADS's general eligibility criteria. These include: • be Pakistani citizens (dual nationals are not eligible); • be currently residing in Pakistan; • not have applied for or hold permanent residency 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 residence; • satisfy Australian Government requirements for international student visas for entry to Australia (heath, character etc.); • be able to clear a Police Security Clearance conducted by a third party on behalf of AusAID; • not hold another scholarship; • not have held a foreign scholarship in the 24 months preceding the application (24 months are calculated from the date of arrival back in Pakistan to the closing date for applications); • be applying to commence a new course of study and not be seeking support for a course already commenced in Australia (on-going study programs will not be supported); • be able to take up the scholarship in the year for which it is offered; • have outlined a case that is clear about their objectives and motivation to make a contribution to development in Pakistan; • be not more than 45 years of age at the time of application. • have completed 16 years of education; • be able to meet the profile specific eligibility criteria under which they are applying (see the four profiles on the ADS website given below); • be applying for a Masters level course; • be applying for courses that fall within the priority sectors identified on the ADS website given below; • satisfy the admission requirements of the Australian tertiary institution and the course to be undertaken; • have a relevant academic background to proposed study in Australia; • be able to demonstrate the ability to meet the English Language Proficiency requirements for the Scholarship; • at the time of application candidates applying under Profile 4 must have a current IEL TS score of 7 with no band less than 6; • candidates applying under Profile 1, 2 & 3 do not need to provide a current IEL TS score at the time of application; however, candidates successful in preliminary screening with no current IEL TS score, will be required to take an IELTS test on short notice (an IEL TS score of 6.5 with no band less than 6 is required for eligibility); • have at least 2 years work experience in the field in which they are applying (5 years experience is required for applicants falling under profile 2); and • must return to his/her home country to take up a position that utilises his/her study for a minimum period of two years.

Useful Australian Websites


For information about Visas - Department of Immigration and Citizenship: http://www.immi.gov.au For information about other Australian Government Scholarships (Australia Awards): http://www.australiaawards gov au

For advice on studying in Australia: http://www.studyinaustralia.gov.au To search for information about Australian http://cricos.dest.gov.au For information on Australian Development Scholarships in Pakistan - http://www.adspaklstan.com.pk cfm Educational Institutions and courses - CRICOS:

For information on the ADS Handbook - http://www.ausaid.gov.au/scholar/studyin THIS DOCUMENT IS NOT FOR SALE

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Application

Form

Title Family Name Given Names

o
o

Mr Other

Mrs

Ms

o Dr

Please specify

(as shown on Passport I NIC) (as shown on Passport I NIC)

Country of Citizenship Gender Date of Birth Passport No.*

!
Male

Female

'If you are waiting for a Passport to be issued, Copy of your Passport should be made available to the ADS office in the country you are submitting this application to, as soon as possible.

Are you living with a disability or working with people who are living with a disability? Under which profile are you applying?

Yes

No

(descriptions of profiles are provided at our website www.adspakistan.com.pk)

Profile 1

o
j

Profile 2

Profile 3

Profile 4

ADS No..
-

OASIS 10.
-

Satisfies Country Specific Selection Criteria

o
0
-

Yes No
--

First Preference
-

Course Name
-

--

--

---

--

Course CRICOS Code Institution/University


I--

--

--

Course Type

--

0 Coursework

o Research

--

Second Preference Course Name Course CRICOS Code Institution/U niversity Course Type IELTS Scores
'--.

0 Coursework
Overall Listening Reading

o Research
Writing Speaking

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What is your country of citizenship? Are you currently residing in your country of citizenship?

o Yes
ONo Country Name (for how long)

(for how long)

Years Months

If not, in which country are you residing

Years

Months

Have you studied overseas in the past? If 'Yes', provide details

Yes

No

Course title: Degree obtained: Duration: Year completed: Country:


r-

Have you applied for permanent residence in

Australia or New Zealand? Are you entitled to Australian or New Zealand permanent residence or citizenshi status? I Excluding holidays or other short visits, have you been granted temporary residence status in Australia?
If 'Yes' provide a visa number and attach a copy of your visa to each application.

o
0 0 0 O

Yes Yes
-~

o
0
Visa no.

No No

Yes No

-----Have you held any Australian Government

t-

scholarshifls in the Rast? _ If 'Yes', provide details Name of Scholarship: Granted by which Australian Agency: Start date: End date: Course Completed: Country where study Completed: Do you currently hold or previously held any other scholarship from your own or another government or s onsor? If 'Yes', provide details r:me of Scholarship: OYes

Yes

No

No

-]

I
I

Granted by: Start date: End date: Course Completed:


______l__

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THIS DOCUMENT IS NOT FOR SALE

Country where study Completed: __

__ J

Once submitted, this scholarship application takes several months to be finalised. Please provide an address where you can be contacted when a decision is reached.

Current residential address Address line 1 Address line 2 Town/City State/Province Home phone no. Mobile no. Email 1 Email 2 (if any) Mailing address Address line 1 Address line 2
+

Postal code (if any) Country Work phone no. Fax no. (if any)

Provide details only if different from your current residential address.

Address line 3
+--

Town/City State/Province

Postal code (if any) Country

Name Relationship to applicant

Address line 1

Address line 2 Town/City Postal code (if any) Country

rstate/province Home phone no. Mobile no. Email

Work phone no.

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If you have dependants (spouse and/or children under 18 years of age), provide their details even if they will not accompany you to Australia. Please note that the scholarship does not provide financial support for accompanying dependants. Family name Given names Gender Country of citizenship
+

Provide family name and other names as shown in your spouse's passport or other official identification document

D Male

D Female

Date of birth

(dd/mm/yyyy)

Passport no.
-

Provide if spouse has a passport.

Will your spouse accompany you to Australia


(Reunion airfare is included or excluded from the scholarships offer based on this clause. See

Yes

No

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Tf-<IS 00GU'v1ENT IS ~C)T FOq SA E

Is English your first language? If 'No', please answer the following: Have you taken an IELTS test? IELTS Scores
(For profile 4 Candidates, IEL TS score of 7 with no band less than 6 is a mandatory requirement for ADS application. For Profile 1,2 & 3 candidates, may provide details, if available')

0 0
Date test taken Overall Score Listening Reading Writing

Yes

No

Yes

ONo

Speaking

Give details of any English language training undertaken / currently being undertaken. *Note: After the preliminary screening, ADS will arrange IELTS test for those successful applicants under profile 1,2 & 3 who have no current IELTS score.

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Past and Current Studies

List by levelof study,startingwithhighest level

-Please include any studies you are currently undertaking and studies you have completed. -Certified copies of Degrees, transcripts (DMCs) and certificates must be included with each application form. -Any documents not in English must be translated and certified copies of English Language translations must be attached. -For 0 & A level examinations, provide Certificates of Equivalence.

1. Qualification Title

Level of study

o Secondary School Certificate o Higher Secondary School Certificate o Vocational, technical diploma/Certificate o Undergraduate D Postgraduate Diploma o Postgraduate

Name of institution Country Language of instruction Status


(complete/incomplete)

Start date

Completion date

2. Qualification Title

Level of study

o Secondary School Certificate o Higher Secondary School Certificate o Vocational, technical diploma/Certificate o Undergraduate D Postgraduate Diploma o Postgraduate

Name of institution Country Language of instruction Status


(complete/incomplete)

Start date

Completion date

3. Qualification Title

Level of study

o Secondary School Certificate o Higher Secondary School Certificate o Vocational, technical diploma/Certificate o Undergraduate D Postgraduate Diploma o Postgraduate

Name of institution Country Language of instruction Status


(completelincomplete)

Start date

Completion date

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4. Qualification

title

Level of study

D D D D

Secondary School Certificate Higher Secondary School Certificate Undergraduate Postgraduate

o Postgraduate

Vocational, technical diploma/Certificate Diploma

Name of institution Country Language of instruction Status( Complete/incomplete) Start date Completion date
form.

If you have included incomplete studies. attach a copy of the results for all completed subjects to each application

ADS are offered to Pakistani Candidates whose proposed course of study will contribute to the long term development needs of the country. It is important to choose a course that falls under a priority sector as declared by ADS. A list of priority sectors is available from the ADS website or in the advertisement published in Newspapers of 6th February 2011 ADS website includes a full list of Australian Institutions that accept ADS students, You need to decide which Institution you would like to attend and choose an appropriate course, To find out about the content of specific courses, you should refer to the individ ual Institution websites, You should choose two courses of study offered by ADS Institutions, The courses may be either at the same Institution, or at different Institutions, If your application for the first preference of study is unsuccessful, ADS office will forward your application to your second choice, If the application for second preference is also unsuccessful. your scholarship offer will be withdrawn,

Provide details of your proposed course of study, in order of preference.


~Jrptl •

r: 1

Course Name Course CRICOS Code Institution/U niversity


(CRICOS code is a 7digit number e,g 0615980)

D Coursework
Course Type

D Research

If you have chosen research, please attach two referee statements and a research proposal

Course Name Course CRICOS Code Institution/U niversity


(CRICOS code is a 7digit number e.q 0615980)

D Coursework
Course Type

Research

If you have chosen research, please attach two referee statements and a research proposal

TI-'IS ocr LMf'\i

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If you do not intend to undertake 50 per cent or more of your course by research, go to Section 10. All Master level applicants whose study program will include at least 50 per cent research MUST attach an outline of the proposed research project (up to 1000 words) to each application form. The outline should address the following: Proposed Title Objectives Relationship of this research to previous work in this field by yourself or others Significance and possible application of your proposed research to your country Where possible, proposed research method and plan including estimated schedule for completion and each step in research and thesis writing. You MUST also attach 2 references in support of your application for a research ADS. If you have already applied to an eligible ADS Institution or had correspondence with an Institution staff member, please attached details and supporting documentation to each application form. Do you intend to undertake fieldwork as part of your research program? DYes

No

If 'Yes', please give details (only one fieldwork trip within Australia or to your country of citizenship is funded under ADS)

Are there any special requirements which you may need to complete your study program in Australia (eg wheelchair access)? If 'Yes', please give details: (Note: the details will not adversely affect your applicatio~

DYes

No

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~H S DOCUMENT IS NOT FOR SALE

Please limit your answers to 100 words per question. Attach a page if there is not enough room.
The answers must be in the applicants own words. It is unethical to plagiarise, paraphrase, apJJlications will be immediately ruled out. copy or quote without citing the source. All such

Why do you want to study in Australia?

b. How will the proposed training be of benefit to your country of citizenship?

What skills and knowledge do you hope to gain from your training in Australia? How do you propose to use them on returnJQ_yourcountry of citizenship? (If possible, list specific actions.)
C.

d. Is there anything else you would like to add in support of your application for this scholarship?

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THIS DOCUMEW IS NOT ~OR SAl
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Provide details if currently employed

Position title Starting date Employing organisation


t-

r
t

Brief description of your duties and responsibilities (maximum 200 words) Will you be returning to this position after your scholarship studies? If 'No', what type of employment do you hope to gain after your studies? (maximum 100 words)
Previous position 1
Provide details if previously employed

Yes

No

Position title
--T-

Starting date Employing organisation ~ -Brief description of your duties and responsibilities (maximum 100 words)
Previous position

Finishing date

[-I

2
T

Provide details if previously employed

Position title Starting date Employing organisation Brief description of your duties and responsibilities ~aximum 100 words~

IFinishing date

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13 a. Employer and Nominating Authority Statement

Are you applying Under profile 1 or 2 ?

DYes
DNo

(Please provide following details) (Go to 13 b)

Support of the nominating/coordinating authority


o be completed by all public sector applicants only in English by an authorised officer from the nominating/coordinating authority.

How will the applicant's selection assist your country's development goals?
~

--------------------~

On behalf of the Government of I declare that I have examined the documents attached to this form and am satisfied that they are authentic and relate to the applicant. I agree that the level and field of study, and length of scholarship and fieldwork proposed in this application are appropriate and in accordance with the Government's human resource development needs and training policy. I nominate Name of nominating authority Contact details Title Organisation for an ADS

Signature Date / /

Official Stamp

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Are you applying through your organization?

DYes
DNo

(Please provide following details) (Please go to 14)


Please Provide detail in Feedback form

Support of the applicant's employer/supervisor


To be completed in English by an authorised officer from your organisation/employer.

Nominated by (name of organisation/employer): Please indicate the specific skills and capacities (not the qualification) you would expect the applicant to gain from the proposed study program:

Name

Position

Contact details

Signature Date / /

Official Stamp

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Applications with incomplete supporting documentation will be rejected. Three HARDCOPIES of the application form are required. EACH copy of the application form should have certified' copies attached of the relevant documents listed below (where applicable). > Where original documents are not in English, applicants must provide certified" copies of English translations.
>

l Required documentation:
A. All Applicants'

please tick if you have attached the following documents in support of your application.

I Copy

of passport personal information pages and/or ID Card

o Yes

IELTS English language test results. Statement from last attended university or school that English is the language of instruction Curriculum Vitae or details about relevant employment One copy of the self-assessment application forms form for eligibility to be attached on top of the three

loo

J
1

Yes Yes Yes

o No o No
0 0 0
No
--<

No

o Yes
_j 0
_ ~_ __

~
No

Recent passport size photographs affixed to the three copies of the application form Employment letters specifying years of service and job description (for all jobs/ years of employment) __ __

I0

Yes Yes

o N0_J o No
-----1

B. Academic Documents: Certified copies of official transcript for Matriculation or 0' Levels (Secondary School Certificate) Certified copies of official transcript for Intermediate or A' Levels (Higher Secondary School Certificate) Certified copies of official transcript and degree for Bachelors level study (Undergraduate) Certified copies of official transcript and degree for Masters level study

0
0

Yes Yes

0 0 0

~OJ
No No No

0 Yes (Postgra-d-:-u-at---:e)-(=If--;I ~es 0

applicable)
Certified copies of official transcript and certificate / diploma for technical I vocational study

(If applicable)
Official English translations of all academic transcripts and degrees (if applicable) C. Research Applicants Only:

Outline of proposed research project (for details see Section 9) . References from two academic referees (if not available, please explain why) List of relevant publications and unpublished thesis D. Other Any other relevant documentation Please list:
* Certified. a statement that the document

o Yes
DYes DYes

DNA DNA DNA

in support of your ADS application

DYes

DNA

..

IS

a true copy, signed by an Oaths Commissioner, Notary Public, first class gazette Public Servant or

other formally recognized authority. If you are unsure about who is the appropriate person to certify your documents, you should contact the Scholarships Manager at ADS Pakistan Scholarships, Level 4, Serena Business Complex, Khayaban-e- Suharwardy, Islamabad. Tel:+92 51 2600186-9 Fax: :+92 512600191 email :info@adspakistan.com.pk.

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Please answer the following questions to the best of your ability. This will assist ADS institutions to determine if you might require additional tuition at the commencement of you studies.

1. Have you used a personal computer (PC)?

0
Details:

Yes

No

2. Have you undertaken any formal PC training?

o
Details: o

Yes

o o
Monthly

No

3. Do you use a PC regularly at work?

Yes

No

r
4. How regularly do you use a PC? o Daily o Weekly

Details:

Yearly

5. Are you an experienced

user of:

a. Word processing software (eg Word)?

fo
Details:

Yes

o
o o

No

b. Spreadsheet

software (eg Excel)?

Yes

No

c. Database software (eg Access)?

[0
1

Details: Yes No

I Doetails: Yes Details: -----

d. Operating systems (eg Windows 2000)?

1
r

o
o o

No

e. Presentation software (eg PowerPoint)?

o
Details:

Yes

No

f. Email software (eg Outlook)?

O__
Details:

Yes

No

f--g. Internet browsers (eg. Internet Explorer)?

---+

o
Details: o Details:

Yes

o
o

No

h. Statistical packages for research students (eg SPSS)?

Yes

No

6. Are there any comments you wish to make about your use of Personal Computers?
r---

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ADS is authorised to collect all items of information in this form under the Australia Awards which includes Australian Leadership Awards Scholarships/Fellowships and Australian Development Scholarships, and is bound by the requirements of the Privacy Act 1988 of the Commonwealth of Australia. Authorisation I authorise AusAID, and/or its appointed managing contractor, hereafter "the ADS", to obtain copies of any of my relevant academic records/reports from the educational institution(s) that I have attended for purposes relating to my application for an Australian scholarship including:

> For use in the selection process;


> To monitor my academic performance at my host education institution if I am awarded the scholarship; > To brief relevant Australian officials, Ministers and members of Parliament. Should I receive an Australian Development Scholarship, I consent to the Australian Government using and disclosing extracts of my application (relating to my academic background and achievements, leadership skills and my proposed study programme in Australia) in promotional material in hardcopy and on the Internet. Promotional material may include, but is not limited to, media releases and information circulated to ADS's offshore counsellors and Australian education institutions, concerning the Australia Awards. I authorise any Australian educational institution that makes me an offer of placement to provide to ADS details of that offer if requested to do so by the ADS. I authorise ADS to advise other Australian Government departments participating in the Australia Awards programme of my scholarship application. Understanding I understand and confirm that > I have read and complied with the instructions to applicants and the contents of my application are true and correct; > ADS has the right to vary or reverse any decision regarding an Australian scholarship made on the basis of incorrect or incomplete information; and > Decisions of the selection panel are final and confidential and no correspondence regarding outcomes of the selection process will be entered into. Agreement If successful in gaining an Australian scholarship, I agree that I will: > Immediately provide ADS with details of any incident that may reflect badly on the prestige of Australian Development Scholarship; > Authorise a third party to conduct my Police Security Clearance on behalf of AusAID; > Act in a manner befitting a recipient of an Australian Scholarship; > Use the funds for the purposes granted; and > Acknowledge the assistance given by the Australian Government in any written reports, publications or publicity associated with the award. Declaration and acknowledgement I declare in submitting this application form that the information contained in it and provided in connection with this application is true and correct. I acknowledge that giving false or misleading information is a serious offence under the Crimina/ Code Act 1995 of the Commonwealth of Australia. Name (title, given names, family name) Signature Date

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Australian Development Scholarships (ADS) 2012 Intake