Application Form Instructions

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1 Application Form Instructions Please use BLOCK LETTERS and BLACK INK (Application form can be filled electronically) Photo Applicants must complete all sections. 1.5 X 1.5 This application must be completed in English For Yes or No questions, indicate your response with an X in the appropriate box. Send one (1) hardcopy of this application form along with all attached documentation by the last date of application at the following address: Office no. 5, Level 1, Serene Business Complex. Sector G-5, Islamabad DO NOT send this application to universities or other education institutions in Australia. Awards are offered to Pakistani Candidates whose proposed course of study will contribute to the long term development needs of the country. Applicants are encouraged to apply through their current organisation; however they can also apply directly. Ensure that the set of application is presented neatly and professionally on A4 paper, vertically secured together in the following order: a. one passport sized photograph of applicant b. application form c. Curriculum Vitae or details about employment d. attested 1 copies of academic qualifications (all degrees and all transcripts) e. attested copies of Employment letters specifying years of service and job description (for all years of employment) f. attested copy of passport and/or National Identity Card g. two professional reference letters with referee contact details If your Australia Awards Pakistan Short Course Awards 2015 application is successful, you will be required to sign a Contract with the Commonwealth of Australia and be bound by conditions of the Australia Awards as included in the Offer Letter. Submitting this application does not guarantee that you will receive an award. General Eligibility Criteria Candidates must: be Pakistani citizens (dual nationals are not eligible), and 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 (health, character etc.); be able to provide a Police Security Clearance certificate at the time of Visa application; 1 A statement that the document is a true copy, signed by an Oaths Commissioner, Notary Public, first class gazetted Public Servant or other formally recognised authority. 1

2 be professionals and faculty members currently employed by higher education institutions in public and private sectors or be professionals currently employed by Business Incubation Centres in the non-academic public and private sector; have proven experience of managing Business/Technology Incubation Centres, Offices of Research, Innovation and Commercialisation or Centres for Entrepreneurship have up to one year of relevant work experience with their current organisation or an organisation of equal relevance to the priority field of Business Incubation Management. Preference may be given to applicants with greater periods of experience; be applying for a short course offered in the field of Business Incubation Management ;2 must meet the minimum eligibility criteria stated as course prerequisites by the Australian tertiary institution providing the course (including English proficiency); where applicable must be able to provide a No Objection certificate from their organisation to participate in the course; must be well positioned to apply the knowledge and experience gained through course participation on their return to Pakistan; must be applying for a short course which is defined as; Opportunities for formal study or training, generally less than three months duration, and no more than 5 months duration; must be able to meet additional course requirements developed by the course provider, if any; must be able to provide two professional reference letters; and must be available to take up the course in November December 2015 Female candidates and people with a disability are encouraged to apply. 2 Course details are available on the website 2

3 1. Personal Details Title Mr Mrs Ms Dr Other Please specify Family Name (as shown on Passport / CNIC) Given Names (as shown on Passport / CNIC) Date of Birth / / Gender Male Female Marital Status Single Married Country of Citizenship Do you have Dual Nationality? Yes No Passport No.* *If you are waiting for a Passport to be issued, copy of your Passport should be made available to the AA office in the country you are submitting this application to, as soon as possible. Issue Date: / / Expiry Date: / / Are you living with a disability or working with people who are living with a disability? Yes No Under which profile are you applying? (Descriptions of profiles are provided at our website ) Profile 1 Profile 2 2. Contact Details Once submitted, this scholarship application takes several weeks 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. Postal code (if any) Country Work phone no. Fax no. (if any) (if any) Mailing address. Provide details only if different from your current residential address. Address line 1 Address line 2 3

4 Town/City State/Province Postal code (if any) Country 3. Emergency Contact Details (person to be contacted in case of emergency) Name Relationship to applicant Address line 1 Address line 2 Town/City State/Province Home phone no. Mobile no. Postal code (if any) Country Work phone no. Fax no. (if any) 4. Qualifications Most recent qualification/degree 1. Qualification Title Level of study Name of institution Country Language of instruction Secondary School Certificate Higher Secondary School Certificate Undergraduate Postgraduate Vocational, technical diploma/certificate Postgraduate Diploma Status (complete/incomplete) Start date / / Completion date / / 5. Applicant s Supporting Statement Please limit your answers to 200 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, copy or quote without citing the source. All such applications will be immediately ruled out. Organisation and title of current position: Starting date: 4

5 a. Description of your current role: b. Major tasks and responsibilities: c. What skills/knowledge do you expect to gain from this course? d. Please I. give up to three practical examples of how you intend to use the knowledge, skills and connections you will gain from participating in the short course. Possible tasks can be personal and/or professional; and II. list any possible constraints you think may prevent you from achieving these tasks. 5

6 6. Will you be returning to this position after your short course award? Yes No If No, what type of employment do you hope to gain after this short course award? (maximum 100 words) 7. Employer Statement (for public sector applicants only) Are you employed by public sector? Yes (Please provide following details) No (Please go to 8) Support of the coordinating authority To be completed by an authorised officer from the coordinating authority. a. How will the applicant s selection assist your institution with the strengthening of its workplace professional development program? Please indicate the specific skills and capacities (not the qualification) you would expect the applicant to gain from the proposed study program and how will these be used in their work upon return. 6

7 b. How will you and your institution support the applicant s negotiated Return to Work Plan (see course outputs in the Course Concept)? 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 short course and fieldwork proposed in this application are appropriate and in accordance with the Government s human resource development needs. I support participation of Name of Supporting authority Australia Awards Pakistan Short Course Awards. Title Organisation for the Contact details Signature Official Stamp Date / / 8. Employer Statement (For private sector applicants) Are you working in private sector and applying through your organisation? Yes (Please provide following details ) No (Please go to 9) Support of the applicant s employer/supervisor To be completed in English by an authorised officer from your organisation/employer. Name of organisation/employer: a. How will the applicant s selection assist your institution/organisation with the strengthening of its workplace professional development program? Please indicate the specific skills and capacities (not the qualification) you would expect the applicant to gain from the proposed study program and how will these be used in their work upon return. 7

8 b. How will you and your institution/organisation support the applicant s negotiated Return to Work Plan (see course outputs in the Course Concept)? Name Position Contact details Signature Official Stamp Date / / 8

9 9. Documentary Evidence Please note: Applications with incomplete supporting documentation will be rejected. One HARDCOPY of the application form is required. The application form should have certified* copies attached of the relevant documents listed below (where applicable). Required documentation: please tick if you have attached the following documents in support of your application. A. All Applicants: Copy of passport personal information pages and/or National Identity Card Yes No Curriculum Vitae or details about employment Yes No Recent passport size photograph affixed to the application form Yes No Two reference letters with referee contact details (professional) Yes No Employment letter specifying years of service and job description Yes No B. Academic Documents: Certified copies of official transcript for most recent qualification/degree Yes No C. Other Any other relevant documentation in support of your application Yes NA Please list: * Certified: a statement that the document is a true copy, signed by an Oaths Commissioner, Notary Public, first class gazetted Public Servant or other formally recognised authority. If you are unsure about who is the appropriate person to certify your documents, you should contact the Scholarships Associate at Australia Awards, Office no. 5, Level 1, Serena Business Complex, Khayaban-e- Suharwardy, Islamabad. Tel: Fax: :

10 12. Applicant s Authorisation, Agreement, Declaration And Signature Australia Awards Pakistan is authorised to collect all items of information in this form under the Australia Awards South and West Asia Program, and is bound by the requirements of the Privacy Act 1988 of the Commonwealth of Australia. Authorisation Department of Foreign Affairs and Trade (DFAT) must comply with the Privacy Act 1988 in relation to the personal information you have provided in this form. By submitting this form I authorise DFAT, and/or its appointed managing contractor, to assess and/or obtain information, including copies of any of my relevant academic records/reports from the educational institution(s) that I have attended for the following purposes: for use in the selection process for an Australia Award; to monitor my academic performance at my host education institution while studying under an Australia Award; to brief relevant Australian officials, Ministers and members of Parliament. Should I receive an Australia Awards Short Course Award, 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. I note that promotional material may include, but is not limited to, media releases and information circulated to DFAT s offshore Posts and Australian education institutions, concerning the Australia Awards. I authorise any Australian educational institution that makes me an offer of placement to provide to Scope Global details of that offer if requested to do so. I authorise DFAT to disclose the personal information collected in this form to other Australian Government departments for the purpose of promoting and managing the Australia Awards. Understanding I understand and confirm that: DFAT has the right to vary or reverse any decision regarding a scholarship made on the basis of incorrect or incomplete information; and Decisions of the assessment panel are final and confidential and no correspondence about outcomes of the assessment process will be entered into. Agreement If successful in gaining an Australia Award, I agree that I will: Undergo a police or character check before my Australia Award is confirmed; Immediately provide DFAT and its appointed managing contractor with details of any incident that may reflect badly on the prestige of Australia Awards; Act in a manner befitting a recipient of an Australia Award; 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 Criminal Code Act 1995 of the Commonwealth of Australia. Name (title, given names, family name) Signature Date / / 10

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