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17 Course Preferences Research Degree Application Form Tick in the box below to indicate your choice of course Doctor of Philosophy (PhD) in Management Doctor of Philosophy (PhD) in Government Professional Doctorate in Business Administration (DBA) Closing Date Office only PERSONAL DETAILS Have you previously studied at, or applied to, the University of Canberra, University of Canberra College (UCC), or Canberra College of Advanced Education (CCAE)? Yes Please indicate your ID Number No Family Name (as in NRIC or Passport) Given Name (as in NRIC or Passport) Title (please circle) Dr Mr Mrs Miss Ms Other Gender (please circle) Male Female Date of Birth (Day/Month/Year) address Passport/Identification Number Phone Number (Home) (Office) (Mobile) Mailing Address (Street) (Town) (State) (Country) Postcode Residential Address (if different from mailing address above) Postcode Emergency Contact Name of Emergency Contact Relationship to you Address Postcode Phone Number Mobile address ENGLISH LANGUAGE PROFICIENCY Applicants are required to provide evidence of English language proficiency. If English is not the first language of learning, the University of Canberra requires Higher Degree by Research students to obtain a minimum academic IELTS overall score of 7.0 with no band less than 6.5 or equivalent for admission. Please tick which is applicable and attach supporting documentation I have undertaken studies within the last 5 years at University level at an English speaking country for a minimum of one year in which the language of instruction was English (please attach certified supporting documentation.) I have undertaken studies within the last 5 years at University level at a non English speaking country for a minimum of two years in which the language of instruction was English (please attach certified supporting documentation.) 1

18 I will take an IELTS test TOEFL test on: (day) (month) (year) IELTS Booking Number: I have taken an IELTS test in the past two years. I have taken a TOEFL test in the past eighteen months INTENDED STUDY Proposed Thesis Title Research Proposal (please attach as a separate document). You must attach your research proposal, and should follow this structure: aims and objectives of the research including the context for the research, a reading list describing the content, and a justification of the research problems/issues to be investigated in the thesis proposed methodology expected resources and conditions required to complete the research (including specialised equipment or software needs, field trips, funding expectations etc) a demonstration of your ability to undertake research at the level required of the degree, by reference to your qualifications, educational or professional achievements, any publications in journals, conference proceedings etc reasons for choosing to undertake the research at the University of Canberra ACADEMIC QUALIFICATIONS Please also include incomplete qualifications and attach certified supporting documentation Qualification Obtained Institution Country Honours Level Completion Date Current Study Are you currently studying? Yes No (please go to the Research Experience section) If yes, please complete the below table. Name of Course Institution Anticipated Completion Date RESEARCH EXPERIENCE Resume Please attach your current resume (including work experience) to your application. Have you undertaken any research or dissertation in your prior academic qualifications? Yes No (if no, please go to Academic Referee section) If yes, please complete the following: Dissertation/Thesis Title Organisation/Institution and Country Type of research and/or the title of thesis/dissertation submitted (indicate whether honours, masters or doctoral) 2

19 Publications (please attach a separate sheet if more than one publication is applicable) Names/titles of relevant projects other than the research Experience ACADEMIC REFEREES Please be aware that referees may be contacted by the University of Canberra for further information. NOTE: Please request referees to complete the attached referee reports to be submitted with this application form. Referee Name Position Contact Details (institutional address, telephone number, fax and address) 1 2 ADDITIONAL INFORMATION Which factors most affected your decision to study at the University of Canberra? Please tick relevant boxes Recommendation of friends and/or family Location of School Courses provided Price Reputation Other (please specify) How did you learn about the University of Canberra? Please tick relevant boxes Source Direct enquiry Exhibition/seminar/road show Recommended by an agent Online advertisement Newspaper/magazine Friend/relative studying at the Asia Global Graduate School Friend/relative studying at the University of Canberra Recommended by my employer Other (please specify) Please specify PRIVACY STATEMENT The University of Canberra is subject to the provisions of the Commonwealth Privacy Act 1988 and you are entitled to protection of your privacy. This means that any information the University collects about you, including personal details, academic progress details, and personal welfare information, is treated by the University according to strict guidelines. Access to your information is restricted to those staff who may need the information in order to carry out their responsibilities in your personal and/or academic interests. After you leave the University, the University may approach you to seek financial or other support. Other than in accordance with any legal or academic obligation, the University will not disclose personal information about you. This means that we do not release any information we hold about you, including your address, or your results, even to close relatives, without your permission. The exceptions to the general application of these guidelines are the obligations imposed on us by law, Government regulation, or the requirements for normal operation of the University. 3

20 They include the following: We inform Centrelink of your enrolment details if you are receiving payments; We release statistical information to the Department of Education, Employment and Workplace Relations (DEEWR) as noted on your Government Statistics form; We disclose the personal information you have given in this application to DEEWR. DEEWR will collect and store this information for use in connection with the Higher Education Information Management System (HEIMS) for the purpose of allocating a Commonwealth Higher Education Student Support Number (CHESSN) to you; We tell the Australian Taxation Office (ATO) about your HELP liabilities; When your award is conferred, your name will be published in the record of proceedings for the conferring of awards; We may publish your examination results and the award of a prize or scholarship; Your data may be included in aggregate socio-economic data by the university for planning purposes; If you are an overseas student or permanent resident we give the Department of Immigration and Citizenship, the Australian Agency for International Development (AusAID) and DEEWR certain information which we are required to release; If you are alleged to have committed a criminal offence, we may be requested to assist the police with personal information about you for the enforcement of the criminal law; and If you apply to transfer to another tertiary institution we may release to that institution or a tertiary admission centre information about your academic progress at this University. DECLARATION I am aware that submission of an incomplete application may delay or eliminate consideration of my application. I declare that all the information I have provided, to the best of my understanding and belief, is complete and correct. I understand that the giving of false or misleading information may lead to the refusal of my application or cancellation of enrolment. I give permission to the University to obtain official records from any educational institution attended by me. As detailed in the Privacy Statement, I authorise the University to supply any relevant official records to government bodies. I understand that information supplied by me to the University of Canberra may be made available to Australian Commonwealth and State Government agencies in accordance with the University s obligations under the ESOS Act 2000 and the national code, available from These obligations include the requirement to advise the appropriate Commonwealth Department of changes to my enrolment and any breach of my student visa conditions relating to my attendance or academic progress. If any information is discovered to be untrue or misleading in any respect, I consent to the University collecting, storing and disclosing this information to the Universities Australia, any of its member institutions, the Australasian Conference of Tertiary Admissions Centres, and any other relevant examining authority. I authorise University of Canberra to obtain further information with respect to my application and, if necessary, seek academic information or transcripts from Australian educational institutions. Where necessary QualSearch will be engaged to access this academic information. I authorise the University to access my Visa status and information using the Visa Entitlement Verification Online Service (VEVO). I understand that University of Canberra is not responsible if any educational body / institution does not supply these records. I understand that the results of the search will be made available to me on request and that an audit of this authority may also be undertaken. Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth). I agree to monitor and communicate with the University of Canberra using my University of Canberra student account, and comply with the rules and regulations governing the conduct of the program or of the University, and/or its local representative. I have read the Privacy Statement and the Declaration above and agree with these conditions Applicant s Signature Date SUBMITTING YOUR APPLICATION Please send your application to the local representative of University of Canberra (CRICOS Provider Code: 00212K): Program Consultant Application Check List: M2 Academy Your full application package should include: 10 Anson Road, #16-01E Duly completed and signed Application Form (inclusive of indicative International Plaza, Singapore research proposal) and attachment, if any Evidence of English Proficiency (if English is not the first language team@m2-academy.edu.sg of learning) Full set of duly certified copy of your educational qualifications and Tel: (65) transcripts Fax: (65) sets of Academic Referee Reports 2 passport-sized recent photos Copy of NRIC (Front & Back) or Valid Passport A full CV detailing your work and professional experience Confidentiality Policy applicable The school is committed to maintaining the confidentiality of our student s personal information Application (names, fee addresses, contacts, assessment results, exam papers and etc) and undertakes not to divulge such information to any unauthorised third party (except to government authorities) without the prior consent of the student. 4

21 Referee's Report Postgraduate Research SECTION A - TO BE COMPLETED BY THE APPLICANT Applicant s Family Name Former Family Name (e.g. Maiden name) Applicant s Given Name Title (please circle) Mr Mrs Miss Ms Other (please specify) Gender (please circle) Male Female Date of Birth address. (Day/Month/Year)... Student ID Number (University of Canberra ID number only, if applicable) Proposed Course Course Number Course Name This report will be required for (please select which apply): Admission to a Higher Degree by Research course Postgraduate Research Scholarship Other (please specify) SECTION B - TO BE COMPLETED BY THE REFEREE Referee s Family Name Referee s Given Name Created on 01/04/2008 Created by Student and Academic Services 1

22 Title (please circle) Mr Mrs Miss Ms Other (please specify) Organisation Position Title Postal Address (please include address, suburb, state, postcode and country) Telephone (Business) Telephone (Home) Mobile/Fax Report Please comment on the applicant s research proposal and research ability. You may wish to be more specific and address the following criteria when commenting on the applicant s academic and research potential: capacity for originality, research ability or potential, capacity for making critical judgements, ability to manage a project and quality of verbal and written communication in general (please attached a separate sheet if more space is needed) Please indicate actual or predicted final award result (if applicable and if known) Not Applicable or Applicable - please specify award Actual result Predicted result Past Academic Record based on the applicant s overall performance and quality of completed work, the applicant is seen as having an academic record achievement that is: Outstanding Very Good Good Average Poor Created on 01/04/2008 Created by Student and Academic Services 2

23 Past Professional Record based on the applicant s overall performance and quality of completed work, the applicant is seen as having a record of professional achievement that is: Outstanding Very Good Good Average Poor Research Potential please indicate the applicant s potential to perform at the level of the course they are applying for: Outstanding Very Good Good Average Poor Scholarship Ranking please rank the applicant in terms of academic standing and/or aptitude to undertake research, in the top: 5% 10% 25% 50% Signature Date Thank you for completing this confidential report. Please keep a copy for your records. Please forward the report directly to: International office Faculty of Business, Government and Law University of Canberra c/o M2 Academy 10 Anson Road #16-01E International Plaza S Tel: (65) team@m2-academy.edu.sg This form may be accessed through a Freedom of Information application. Created on 01/04/2008 Created by Student and Academic Services 3

24 Application Form Course Name Graduate Diploma in Management Research (GDipMR) leading to University of Canberra: Professional Doctorate in Business Administration (DBA) PhD in Management or Government Closing Date Office only PERSONAL DETAILS Have you previously studied at, or applied to, the University of Canberra, University of Canberra College (UCC), or Canberra College of Advanced Education (CCAE)? Yes Please indicate your ID Number No Family Name (as in NRIC or Passport) Given Name (as in NRIC or Passport) Title (please circle) Dr Mr Mrs Miss Ms Other Gender (please tick one) Male Female Nationality (please tick one) Singapore Citizen Others (Please specify) Date of Birth (DD/MM/YYYY) address Passport/Identification Number Phone Number (Home), (Office), (Mobile) Mailing Address Postcode Residential Address (if different from mailing address above) Postcode Emergency Contact Name of Emergency Contact Relationship to you Phone Number (Home) (Office) (Mobile) ACADEMIC QUALIFICATIONS Please attach certified supporting documents Qualification Obtained Institution Country Honours Level Completion Date 1

25 ENGLISH LANGUAGE PROFICIENCY Applicants are required to provide evidence of English language proficiency. If English is not the first language of learning, the University of Canberra requires Higher Degree by Research students to obtain a minimum academic IELTS overall score of 7.0 with no band less 6.5 for admission. Please tick which is applicable and attach supporting documents I have undertaken studies within the last 5 years at University level at an English speaking country for a minimum of one year in which the language of instruction was English (please attach certified supporting documentation.) I have undertaken studies within the last 5 years at University level at a non English speaking country for a minimum of two years in which the language of instruction was English (please attach certified supporting documentation.) I will take an IELTS test TOEFL test on: (Day) (Month) (Year) (Booking number) I have taken an IELTS test in the past two years. Overall band score: I have taken a TOEFL test in the past eighteen months. Total score: INTENDED STUDY AREA Proposed Research Area (Please attach a brief description of your intended research area/topic in no more than one page) DECLARATION I declare that all the information I have provided are correct and complete. I acknowledge that provision of incorrect or misleading information may result in enforced withdrawal from the program without compensation or refund. I have no objection for M2 Academy to obtain further information if necessary, with respect to my application, from my previous educational institutions. I agree to comply with the rules and regulations governing the conduct of the program by M2 Academy. I understand that the University of Canberra (UC) has a formal articulation arrangement with M2 Academy to admit Master s degree holders who have completed M2 Academy s Graduate Diploma in Management Research (GDipMR) program into Semester 2 of UC s DBA program in Singapore, or gain enrolment into UC s PhD in Management/Government program in Singapore, subject to the production of a Research Proposal which meets UC s PhD/DBA requirements. I understand that I will only be progressed into UC DBA program if my research proposal is assessed by UC to be capable of culminating in a project thesis that will make contribution business policy and practice, and I will only be enrolled into UC PhD program officially, if my research proposal is assessed by UC to be capable of culminating in a thesis that will make contribution to the body of knowledge. I agree that progression into either the DBA or PhD program is an academic decision at the sole discretion of UC. I have read the Declaration above and agree with these conditions Applicant s Signature Date SUBMITTING YOUR APPLICATION Please send your application to: Program Consultant M2 Academy 10 Anson Road, #16-01E International Plaza, Singapore team@m2-academy.edu.sg Tel: (65) Fax: (65) Application Check List: Your full application package should include: Duly completed and signed Application Form Evidence of English Proficiency (if English is not the first language of learning) Full set of duly certified copy of your educational qualifications and transcripts Write-up of Intended Research Area/Topic (approximately 1 page in length) 2 passport-sized recent photos Copy of NRIC (Front & Back) or Valid Passport A full CV detailing your work and professional experience Application fee Confidentiality Policy The school is committed to maintaining the confidentiality of our student s personal information (names, addresses, contacts, assessment results, exam papers and etc) and undertakes not to divulge such information to any unauthorised third party (except to government authorities) without the prior consent of the student. 2