Australia-China Young Scientists Exchange Program 2016

APPLICATION FORM

APPLICATIONS CLOSE 09:00AM (AEST) MONDAY 20 JUNE 2016

TITLE / FIRST NAME(S) / SURNAME
Place of Birth / Date of Birth
Position
Organisation
Mailing Address
Email / Mobile
Have you previously participated in the Australia China Young Researchers Exchange Program or the Australia China Young Scientist Exchange Program? / YES/NO
Have you lived, studied and/or worked in China for longer than a total of 3 months? / YES/NO
Are you are an Australian citizen
OR
Australian permanent resident and you were not born in Australia
At the end of the application form please attach
  1. Front page of your passport with full name, date and place of issue and expiry date
  2. If you are not an Australian citizen, please attach proof of Australian permanent residency status
/ YES/NO
YES/NO
PASSPORTNUMBER / PLACE/DATE OF ISSUE
Qualification / Institution (Include country if outside Australia) / Date
PhD (or equivalent research doctorate) details
Year awarded
Institution
State/Country
Field/s of research
Employment history
Position held / Employer, including country / Date of employment

Include one-page CV and a list of five of your most relevant publications at the end of the application form.

Briefly describe your research career (e.g. information about your research career path and any research career interruptions. Maximum 300 words
Please outline your research achievements, including research awards and grants
Research Grant/Award / Name of Funding Organisation / Duration / Funding Amount
Please detail major past and current research projects, including their research objectives and outcomes. Maximum 500 words
Institutional details / Research Project and outcomes
Please detail the potential of your current and future research projects to involve collaboration with China and the potential to develop and maintain links with your Chinese research partner/s. Maximum 300 words
Describe the added value to your research discipline, institution and wider society from the potential cooperation with China, and the potential outcomes of mutual benefit to both countries. Maximum 300 words
Specify Chinese researchers and/or institutions that you, or your institution, would like you to visit during your Exchange Program to enhance Australia China S&T Linkages
Please list at least three and no more than five, in order of priority with a maximum of 3 cities (Beijing is not included in three city limit)
Name and position of researcher / Department and Institution / Email / Mobile
Please indicate your expectations of these visits
This may include general or specific outcomes you hope to achieve during your visit

Declaration:

I the applicant confirm that the information provided in this application is true and accurate. If selected, I will spend the funding in accordance with the stated aims of the project; comply with all conditions as set out in the Terms and Conditions of the scheme guidelines.

I acknowledge that the Commonwealth will not be liable for any injury, damage or loss I suffer in connection with the Australia-China Young Scientists Exchange Program.

I will provide the required visit report within 30 days of my return to Australia and in 12 months’ time and complete any surveys or request for information deemed necessary by the Department or sponsoring institutions for the purposes of evaluating the program.

Applicant’s Signature
Date
Endorsement of Eligible Research Organisation
Name in full
Position held
Institution
Email / Mobile
Date

APPLICATIONS ARE DUE BY 09:00AM(AEST) MONDAY20 JUNE 2016

LATE APPLICATIONS WILL NOT BE ACCEPTED

Please send to Dr Carolyn O’Brien at

  • Do not include the first three pages of guidelines with the completed application form
  • Please attach a one-page CV with titles of five of your most relevant publications
  • Please attach front page of your passport and, if not an Australian citizen, documentary evidence of permanent residency status

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