Effects of Diet and Exercise on Mood, Cognition and Quality of Life in Overweight Adults
PhD Scholarship
APPLICATION FORM
To be considered for scholarship, applicants must submit a completed postgraduate scholarship application form together with all the required supporting documentsto the ACUGraduate Research Office in Melbourne at Locked Bag 4115, Fitzroy 3065, Victoria. To be considered applications must be received by the close of business, 28 February 2014.
Applicants for scholarships will only be considered if they have also submitted an application for research candidature or are already enrolled as a Research Higher Degree student.
NB: The following form is for scholarship applications only. A separate application form is required for research candidature and should be forwarded to the Graduate Research (Studies) office in the state in which you are intending to apply for candidature noting that only one set of documents e.g. transcript, testamur etc should be provided.
Are you currently receiving a postgraduate award?
Have you previously received a postgraduate award?
(A)PERSONAL DETAILS
Title:
First Name:
Surname:
Date of Birth:
Gender:
Postal Address:
Residential Address:
Phone (BH):
Mobile:
Email Address:
ACU Student Number (if applicable):
Country of Citizenship:
Other residencies:
(B)CANDIDATURE
Name of Course:
Enrolment Status:
Course Commencement Date:
Faculty:
Supervisor (if enrolled):
Co-Supervisor (if enrolled):
Summary of Research Intentions (limit 1,000 characters):(C)QUALIFICATIONS
Degree / Institution / Length / Start / End / Grade / ResearchComponent%
(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 / PagesList any conferences you have presented at and conference proceedings your work has been published in:
Author/s / Year / Title / Conference proceedings / LocationBriefly 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)
(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 StudiesOffice 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 applicant’s responsibility to forward the referee report forms to their nominated referees.
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First Referee:
Title:
Name:
Position:
Department:
Institution:
Address:
Country:
Postcode:
Email:
Phone:
Fax:
Second Referee:
Title:
Name:
Position:
Department:
Institution:
Address:
Country:
Postcode:
Email:
Phone:
Fax:
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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 ACUGraduate Research StudiesOfficer 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 applicant’s responsibility to supply all support documentation relevant to their application. With the exception of confidential referee reports, the Graduate Research Studiesoffice 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 Institution’s 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:
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