Diabetes Queensland

PhD Scholarship Application

Please read before completing

  • The closing date above shows the date on which electronic and hard copies of applications are to reach Diabetes Queensland.
  • This application form must be completed using 12 point Arial.
  • All sections of this application must be completed. Both electronic and hard copies of your applications must be identical.
  • Applications not adhering to these guidelines will not be accepted.

Scientific project title
Title / Ms / Mr / Dr / Other (Please specify) ______
First name / Surname
Telephone / Mobile
Email

Administering institution

Name / Address
Where funds will be administered
ABN / State
Current Appointment / Commencement Date
Current Salary
Current Institution / State
Citizenship/Immigration Status / Relevant document(s)
Australian Citizen / Attachcopy of passport, birth certificate or citizenship certificate.
Permanent Residence / A copy of an Australian permanent resident certificate or evidence of submission for an Australian Permanent Resident certificate attached.

PhD Commencement

Have you Commenced your PhD?
  • If you have completed the equivalent of more that 1 year of your PhD at 1.0 FTE at the closing date of application, you are ineligible to apply (e.g. 1 year @ 1.0 FTE = 2 years @ 0.5 FTE).
  • You must include a Letter from your University indicating the start date of your PhD
/ Yes
No
If you have already started your PhD, please indicate what your FTE has been to date (e.g. 1.0 FTE = Full Time, 0.5 FTE = Half of Full Time) / ______FTE
Please nominate either the date you started your PhD or your intended start date / dd/mm/yyyy
If you are successful for a Diabetes Queensland Scholarship, when would you like to start your tenure? (select one of the specified dates) / 1st July 2014
1st January 2015
Please confirm you will be studying full-time / Yes

Summary of academic and professional qualifications:

Year / Degree / Conferring Institution
Applicant’s Curriculum Vitae
Please attach your CV (2 pages maximum) / Attached
Title / Dr / A/Prof / Prof / Other (Please Specify) ______
First name / Surname
Qualifications
Institution / Department
Telephone / Mobile
Email
Primary Supervisor’s Curriculum Vitae
Please attach primary supervisor’s CV (2 pages maximum) / Attached
NAME / EMAIL
REFEREE 1
REFEREE 2

PLEASE NOTE: Referee reports must be submitted prior to the closing date. It is an applicant’s responsibility to ensure referee reports are submitted on time. Late referee reports will not be accepted under any circumstances.

Include publications which have been published, or accepted for publication, in refereed journals. The list must be numbered and each reference must include authors, journal name, journal title, year and page numbers. Please add impact factors and citations for each of your publications as well as the relative ranking of each journal within its field (if available). Please indicate the role you had in each of these publications.
Papers:
Abstracts:
Describe your overall career aspirations In particular, focus on your commitment to research, diabetes research and future career plans. (Half page maximum)
Provide details of significant scientific and community achievements, awards, administrative, teaching, research, community and/or other professional experience. (One page maximum)
YES / No
Is this application also under review by any other funding body, or do you intend to submit this application to any other funding body? IfYES, please provide details
Funding Body / Details of Application
(include award category & reference number if known)
Please suggest organisations that may be interested in co-funding this application.
Note: This will not affect the funding outcome.

Research funded by Diabetes Queensland shall be conducted in accordance with the Australian Code for the Responsible Conduct of Research (2007). Clearances for research that involves any of the following shall be obtained from the appropriate Ethics Committee and/or Biosafety Committee and submitted to Diabetes QueenslandResearch Office before funding is released.

YES / NO
Does this project involve experiments on human subjects?
Does this project involve experiments on animals?
Does this project involve genetic manipulation of organisms or the use of radioactive substances, recombinant DNA, potent teratogens, carcinogens or toxic chemicals?

By completing and submitting this application, I acknowledge that I will abide by the Australian Code for the Responsible Conduct of Research (2007), obtaining all ethics approvals and clearances as are necessary to complete my project as outlined in this application. I further consent to inform Diabetes Queensland of all applications for ethics clearance and confirm I will forward all approvals as they are received (or within 30 days of receiving them).

I also understand that failure to provide these clearances as they are required or failure to secure ethics approval for my project may result in my funding being suspended until such time as clearances have been submitted to Diabetes Queensland.

(a) Applicant & Supervisor

  • I certify that all details given in the application are correct and I agree to carry out the project in accordance with Diabetes Queensland’s current Funding Deeds for Scholarships and in accordance with the principles of the Australian Code for the Responsible Conduct of Research (2007).
  • By signing, I confirm that I have complied with all instructions in the application form and understand that failure to do so may result in the withdrawal of my application from the review process.
  • I acknowledge that all supporting documentation has been provided with this application. I understand my application will not be eligible for consideration by Diabetes Queensland if this application is incomplete or does not include the required documentation.
Applicant
Full Name
Signature / Date / ___/___/14
Supervisor
Full Name
Signature / Date / ___/___/14
(b)Head of Department
  • I certify that appropriate facilities will be available to the applicant if successful and that I am prepared to have the project carried out in accordance with the Funding Deeds for Diabetes Queensland Scholarships.

Title / Full Name
Position
Department / Institution
Signature / Date / ___/___/14
(d)Verification by Research Administrative Officer
  • I verify that I have checked this application and that to the best of my knowledge all instructions included in this form have been complied with and all relevant details and documentation are correct and included with this application at the time of lodgement with Diabetes Queensland.
  • In addition, I verify this institution has established administrative procedures for assuring sound scientific practice in accordance with the principles of the Australian Code for the Responsible Conduct of Research (2007).

Title / Full Name
Position
Department / Institution
Phone / Fax
Email
Signature / Date / ___/___/14

ATTACHMENT ONE

This should be suitable for release to the media or for general publication

Describe the overall aims of the research and expected diabetes outcomes. AVOID the use of technical terms. This should be suitable for release to the media or for general publication (15 lines maximum).

(A) Specific Aims – List the specific aims and hypotheses to be tested (15 lines maximum).

(b) Potential Outcomes - How will your research contribute to the Diabetes Queensland mission of to improve the lives of people affected by all types of diabetes. (15 lines maximum)

(A) Applicants may provide up to TWO PAGES MAXIMUM under this heading, including references. Figures must be included within the two pages.

(B) Briefly describe how the host institution can support your research – both as outlined in your research plan and in your research career development (15 lines maximum).

Please ensure that BOTH Hardcopy and Electronic copies are identical and submitted to Diabetes Queensland by the closing date. Applications must be submitted via the Research office of your institution.

Hardcopy application must include the following: / Please Tick
  • One original copy of completed and signed Application Form

Both hard copy and electronic copy must include the following:
  • Curriculum vitae of applicant (2 pages maximum)

  • Curriculum vitae of supervisor (2 pages maximum)

  • Academic transcripts of applicant

  • Referee reports (2 referees required)

  • Proof of Australian citizenship or permanent residency.

  • Human, animal or bio-safety ethics clearances if available (if your Scholarship is successful, you will be required to supply clearance prior to funding being released).

  • Letter from your University indicating the start date of your PhD (or equivalent degree)

Electronic application must be submitted in 3 separate PDF files (no more than 5MB each).
  • File 1:Application Form

  • File 2: Supporting Documentation 1
  • A copy of passport, birth certificate or citizenship certificate (to show Nationality) OR Australian permanent residency certificate OR evidence of submission for an Australian Permanent Resident certificate attached
  • Ethics clearances if available (if your Scholarship is successful, you will be required to supply clearance prior to funding being released).
  • Letter from your University indicating the start date of your PhD (or equivalent degree)

  • File 3: Supporting Documentation 2
  • CV of applicant (2 pages maximum)
  • CV of primary supervisor (2 pages maximum)
  • Academic transcripts of applicant
  • Referee reports 1 & 2

DQ PhD Scholarship Application