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APPLICATION FORM

· Admission To Research Higher Degree

· Postgraduate Research Scholarships for 2017

If you are a current student or recent graduate of Flinders University, you must apply online via the Student Information system.

If you are not a current student or recent graduate and applying for both admission to a research higher degree at Flinders University and a postgraduate research scholarship, please complete all of this form. If you are currently enrolled in a research higher degree at Flinders University and wish to apply for a postgraduate research scholarship, please apply via the My Scholarships tab on the Student Information System.

Make sure you complete all relevant sections of the form. For further information refer to the Application Guidelines and Information, Admission to Research Higher Degree, Postgraduate Research Scholarship document.

Please email your completed application and supporting documentation to the Student Finance Office at:

rhd.

Applications for Australian Postgraduate Awards and Flinders University Research Scholarships close at 5pm on 31 October 2016.

Notes: 1. Applicants for the PhD (Clinical Psychology) must also obtain a separate application for admission form available

from the Faculty of Social and Behavioural Sciences.

PERSONAL DETAILS

Name:

/ / / / / /
Title (Mr, Ms etc) / Family name / First Given Name / Second Given Name

Previous Name:

Student ID number:

Any previous family name (if applicable) / / (if currently/previously a Flinders student)

Date of Birth:

Gender:

/ Male / Female
Day / Month / Year
Address details:
Street address or GPO Box
Suburb or town / State or country / Postcode
Contact telephone number / Mobile phone number / Fax number
Email address:

Citizenship Status: / Australian citizen
New Zealand citizen
Permanent Resident of Australia
(but not an Australian citizen)
Holder of a student visa, temporary resident visa or visitor visa
Other
Permanent Residents only
Date residency granted:
Did you meet residency requirements
for citizenship more than one year ago? / Yes / No
Will you be residing in Australia during
the study period? / Yes / No

International applicants only

Indicate type of Visa
Country of Citizenship

Country of birth
(if not Australia) / Year of entry
(to Australia) / Main language spoken at home
Aboriginal or Torres Strait Islander status: / Aboriginal / Both Aboriginal and TSI
Torres Strait Islander / None of the above
Disabilities: / Do you have a disability or medical condition which may affect your studies? If “Yes”, please indicate below any disability that applies. / No / Yes
Hearing / Learning / Medical / Vision / Mobility / Other
Would you like information on support services? / Yes / No

COURSE DETAILS

Indicate the course for which you wish to be considered for admission or in which you are currently enrolled.

Master of Arts / Master of Engineering / Master of Clinical Education
Master of Arts in Applied Population Studies / Master of Laws / Doctor of Education
Master of Arts (Social Work) / Master of Science / Doctor of Philosophy (Clin Psych)
Also complete School of Psychology’s form to apply for admission to this degree
Master of Biotechnology / Master of Surgery / Doctor of Public Health
Master of Business / Master of Theology / : Doctor of Philosophy
Master of Clinical Rehabilitation / Other:
Are you currently
enrolled in this course? / No / Yes / I wish to undertake/am
enrolled in this course: / Full-time / or / Part-time
If Yes, year of commencement: / AND wish to be/am enrolled on the following basis: / Internal / or / External

Broad field of study in which you are interested

School/Department/Unit in which research will be/is being undertaken

ACADEMIC DETAILS

Are you currently enrolled/previously been enrolled in a research higher degree? / No / Yes / (provide details below)

List in chronological order all university or other post-secondary courses attempted or completed.

Name of Degree/Award / Institution / Major Field of Study / Attempted but not completed. Enter year last enrolled / Completed or about to complete. Enter year last enrolled

Degrees and Awards: Original or certified copies of academic transcripts, showing all subjects attempted and grades received, except for studies undertaken at Flinders University, MUST be attached to this application.

Research Experience: A brief summary of your research experience must be attached. Include details of any publications, research grants, patents, creative works or employment experience relevant to your proposed research project.

Academic referees: Provide the names and contact details of two academic referees. The faculty or Scholarships Committee may contact the nominated referees in relation to the reference provided. Nominated academic referees should have an informed, personal and professional knowledge of your academic ability and should be able to exercise judgement of your research potential. It is recommended that you select the supervisor of the most recent tertiary program in which you are/were enrolled or the Head of Department or the Postgraduate Coordinator of the Department.

*NB If you are applying for a scholarship these referees may also be required to submit a written reference by the scholarship application deadline (written reference not required for graduates of an honours degree at Flinders University). Please see page 4 for further details on the number of written references required.

First Referee
Name:
Position:
Address:
Email:
Second Referee
Name:
Position:
Address:
Email:

APPLICATION FOR POSTGRADUATE RESEARCH SCHOLARSHIP

Are you applying for an Australian Postgraduate Award (APA) and/or Flinders University Research Scholarship (FURS)? Please note the closing date of 31 October 2016.

No / Yes

Applications for APA/FURS will also constitute an application for the following scholarships:

· Professor Lowitja O’Donoghue Indigenous Student Postgraduate Research Scholarship

· Faculty of Science and Engineering Research Awards (FSERA)

· Faculty of Medicine, Nursing and Health Sciences Stipend

· Joyner Scholarships in Arts, Law, Medicine and Science

· AJ and IM Naylon PhD Scholarship

· Advanced Community Care Scholarship

· Lions Medical Research Foundation Incorporated Scholarship (offered once every three years)

· Jim Main Doctoral Scholarship (only one scholarship will be active at a time)

Information and eligibility criteria for these scholarships can be found at http://www.flinders.edu.au/scholarships-system/main-display-postgraduate.cfm. International applicants will be eligible for a FURS only and not other scholarships listed above.

Applications for scholarships not listed above must be specified below.

Are you applying for a scholarship not listed above?

No / Yes / If “Yes”, Name of Scholarship:

Have you already commenced the degree for which you are seeking the scholarship?

No / Yes / If “Yes”, Name of Supervisor:
If “No”, you must complete the Application for Admission to a Research Higher Degree on page 3 of this form.

Are you currently, or have you previously been, in receipt of a research scholarship or other postgraduate award?

No / Yes / If “Yes”, attach a statement detailing the nature of the award. Include the name of the award, its value, the year it was granted, how long you held the award, the institution where you held the award, and the study funded by the award.

Do you have any publications?

No / Yes / If “Yes”, complete a Publication Details form for each publication or other work that you wish to submit in support of your application. Provide a copy or offprint of the publication if fewer than 5 pages in length, or a photocopy of the first 5 pages of the publication showing all bibliographic information. See the Publications section of the Guidelines for Ranking Applications for further information.

Referees Reports

Do you hold, or are you completing an Honours degree from Flinders University?

No / Yes / If “Yes”, you are not required to provide referee’s reports, unless instructed to do so under the Additional Information section below.

Do you hold or are you completing an Honours degree from another Australian university?

No / Yes / If “Yes”, ensure one of your nominated referees submits a reference by the application deadline, unless instructed to provide two reports under the Additional Information section below.

Do you hold a qualification other than an Honours degree?

No / Yes / If “Yes”, please complete the Additional Information section below.

Additional InformatioN for SPECIAL CASES: (For further information refer to the section on Special Cases in the Guidelines for Ranking Applications.)

Do you hold a Masters degree by research?

No / Yes / If “Yes”, ensure both of your nominated referees submit references by the application deadline. Attach copies of examiner's reports for your Masters degree if these are available. A Masters degree by research is normally considered equivalent to Honours 1, Band B. Applicants holding a Masters degree by research may request that their degree be considered equivalent to Honours 1 Band A. Such requests must be supported with written evidence.

Do you hold a coursework Masters degree with a graded research component?

No / Yes / If “Yes”, ensure both of your nominated referees submit references by the application deadline. Attach a statement giving details of the duration of the degree, weighting of the research component, the mark and grade for the research component, and a statement of grading. Attach copies of examiner's reports for the research component of your coursework Masters degree if these are available.

Do you hold a coursework Masters degree with a non-graded research component?

No / Yes / If “Yes”, ensure both of your nominated referees submit references by the application deadline. Attach a statement that details the duration of the degree and weighting of the research component. Attach copies of examiner's reports for the research component of your coursework Masters degree if these are available.

Do you hold an Honours degree at 2A level, which was awarded more than five years ago?

No / Yes / If “Yes”, ensure both of your nominated referees submit references by the application deadline. Attach a statement that details how your research potential has changed since your degree was awarded.

Do you have any other academic qualifications and/or research experience?

No / Yes / If “Yes”, ensure both of your nominated referees submit references by the application deadline. Attach a statement giving details of the qualifications and/or research experience.

APPLICATION FOR ADMISSION TO A RESEARCH HIGHER DEGREE

Note: Applicants for the PhD (Clinical Psychology) must also complete a separate application for admission form available from the Faculty of Social and Behavioural Sciences.

Before completing this section, you MUST contact the Head of the School/Department/Unit (or the Director of Studies or Postgraduate Coordinator) in which the research is likely to take place, to ascertain whether the research project can be accommodated. You will only be accepted for admission to candidature if the University is able to provide research facilities and supervision appropriate to the proposed field of research.

The information about research expertise at Flinders University at http://www.flinders.edu.au/research/our-research/research-expertise.cfm may provide assistance in identifying a potential supervisor.

Proposed supervisor of research:
Expected date of commencement:
Indicate the number of hours per week available to pursue studies:

Research proposal

Attach a research proposal, approximately 500 words in length, which details the problem, hypothesis or question that you will examine, the methodology or approach that you will use and the anticipated resources required for the research project to be viable. You are strongly advised to prepare your research proposal in consultation with a potential supervisor.

Employment details

Will you be employed while studying for a research higher degree? / No / Yes / If “Yes”: / Full-time / Part-time

If employed, please specify:

Your position: / Employer’s address:
Employer:

A written statement may be required from your employer indicating the proportion of normal working hours that will be available for you to undertake your proposed studies and certifying that your release from normal duties for that time has been approved. Please note that scholarship holders are limited to 8 hours per week of work for the duration of their scholarship.

Office Use Only: Application for Admission
Decision:
Authorised: / __ / __ / __
Entered: / __ / __ / __
Comments:
Student Advised: / __ / __ / __

DECLARATION

I certify that to the best of my knowledge all documentation and information submitted or made available by me to the University, whether in relation to any course of study or otherwise, is true, accurate and complete. I acknowledge that the provision of inaccurate or incomplete information by myself, or a certifying authority, may result in the withdrawal of any offer of enrolment, the cancellation of any enrolment allowed on the basis of acceptance of that offer and/or the cancellation of a scholarship at any time prior to or during my enrolment. I consent to the collection, storage and disclosure of information relating to record falsification or other irregular acts in accordance with Universities Australia procedures. I authorise Flinders University to obtain from other educational institutions details of my enrolment and academic record at those institutions. I authorise Flinders University to release information on my application for a scholarship to organisations offering scholarships for which I may be eligible.

Signature of Applicant / Date

Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth).

APPLICATION FORM CHECKLIST

Incomplete or late applications will not be considered, please check
you have provided the following as per the application guidelines: / Yes / No / Not Required
· Original or certified copies of academic transcripts for all studies attempted, except study at Flinders University.
·
· A brief summary of your research experience including details of any publications, research grants, patents, creative works or employment experience relevant to your proposed research project.
·
· A research proposal approximately 500 words in length.
· Details of currently or previously held scholarships or postgraduate awards.
· An Applicant Publication Details form for each publication or other work that you wish to submit in support of your application.