Australia Awards Scholarships

2014 Intake Application Form

Instructions
Please print neatly using block letters (huruf cetak) and black ink
> Before completing this form, you must read the Australia Awards Scholarships Policy Handbook
(www.ausaid.gov.auaustralia!awards"ocumentsscholar!handbook.pdf# and the $ndonesia country profile
(http%www.ausaid.gov.auaustralia!awards"ocumentsindonesia.pdf#. Applicants also are encouraged to review all
information available on the Australia Awards Scholarships & $ndonesia website (www.australiaawardsindo.or.id#
> 'ou must complete all fields marked with an ( and all relevant sections.
> )his application must be completed in *nglish.
> +or ,'es- or ,.o- /uestions, indicate your response with an ,0- in the appropriate bo1.
> 2ne (3# copy of this form and of all attached documents must be received by 19 July 2013 at the Australia Awards
2ffice at 4edung 5irausaha, 6
th
+loor. 7l. H.8. 8asuna Said 9av.:!; 9uningan, 7akarta 3<=>?.
> "o not send this application to universities or other institutions in Australia.
> Australia Awards Scholarships will be offered only to those whose course of study will contribute to the long!term
development needs of $ndonesia. A list of the priorities is available under ,:hoosing a :ourse of Study- on page @
of this application form.
> AusA$"As website includes a list of Australian Bniversities that may receive Australia Awards Scholarship
recipients. :ourse of study information is available directly from the BniversitiesA websites or the :ommonwealth
8egister of $nstitutions and :ourses for 2verseas Students (:8$:2S# website (see page C & Bseful 5ebsites#.
> 'ou may provide two preferences for courses of study. 'ou should consider two Australian universities rather than
two courses at the same university, Dust in case you do not meet the admission re/uirements of the first Australian
university.
> $f your application is successful, you will be re/uired to sign a :ontract with the :ommonwealth of Australia and be
bound by conditions of the scholarship. A full list of the conditions is contained in this application form (page <; !
<C# and in the Handbook. Please note that AusA$" reserves the right to change these conditions at any time.
> Submitting this application does not guarantee that you will receive a scholarship.
> $f you do not receive an invitation to an interview from the Australia Awards office by mid!"ecember, you should
assume that your application has been unsuccessful.
> Applicants must not fill in section <; of the application form. )his section is for use by the Einistry of State
Secretariat of the 8epublic of $ndonesia (9*ES*).*4# and refers only to selected candidates.
> $n cases where information supplied by candidates is found to be inaccurate or incorrect, an award offer may be
revoked without notice.
The closing date is 19 July 201
Applications should !e su!mitted as early as possi!le
1
"eneral In#ormation $otes
Australia Awards Scholarships are an important component of AustraliaAs investment in education. $n $ndonesia,
Australia Awards Scholarships provide opportunities to study in Australia at P2S)48A"BA)* level. )hey are provided
to $ndonesian citiFens to provide enhanced leadership, knowledge and technical skills to the 4overnment of $ndonesia,
to tertiary institutions and to strategic organisations that are driving sustainable development.
Australia Awards Scholarships have been an important component of the Australian 4overnmentAs efforts
to reduce poverty and achieve sustainable development since the 3=;?s. )his is achieved through%
developing capacity and leadership skills so that individuals can contribute to development in $ndonesiaG
building people!to!people linkages at individual, institutional and national levels between $ndonesia and Australia.
)here are a number of supplementary programs associated with Australia Awards Scholarships in $ndonesia
including the Australia Awards Headership Program and the Allison SudradDat PriFe.
Public applicants are from government organisations, state universities and state owned enterprises and must be
approved by training or foreign cooperation bureaus (B9H.# of their local or central agencies (see page <@#. Public
applicants from government agencies outside 7akarta may apply directly to the ABS)8AH$A A5A8"S
S:H2HA8SH$PS program office with the approval of their relevant Kakanwil or Kadinas and approval from Bupati or
4overnor (or representative# where necessary. Calon Pegawai Negeri Sipil (:P.S# are not eligible to apply.
Open applicants are from private organisations, private universities and also include recent university graduates. .o
government approval is re/uired and applications are to be submitted directly to the Australia Awards office. A letter of
support from the applicantAs home agency, institution or private university may be included with the application. Public
servants ( p egawai n egeri # cannot apply as Iopen applicantsA.
Targeted and on!Targeted "ategory
ABS)8AH$A A5A8"S S:H2HA8SH$PS are awarded as ITargeted or INon-Targeted. Bp to 6?J of ABS)8AH$A
A5A8"S S:H2HA8SH$PS are TargetedG available for nominated staff from 4overnment of $ndonesia 9ey Agencies,
)argeted Sectors and from AusA$" 4eographic +ocus Areas
3
. +urther information on each of these sub!categories is
available at www.australiaawardsindo.or.id
At least @?J of ABS)8AH$A A5A8"S S:H2HA8SH$PS are on!Targeted available for public servants and non!
public servants outside the AusA$" 4eographic +ocus Areas.
Scholarships are for full!time study for a Easters or "octorate degree from Australian tertiary institutions. )he
scholarship provides up to nine months full!time language and academic preparation in $ndonesia. Students must
achieve satisfactory results in this training to be able to continue their scholarships.
#ocial inclusion
*ligible candidates with a disability or from organisations working with the disabled are encouraged to apply. 5omen
and candidates within AusA$" 4eographic +ocus Areas are also encouraged to apply.
%ligi!ility
$ %&&'() "(*$*(T&# +,#T-
> be an $ndonesian citiFen and be residing in and applying for the scholarship from $ndonesia
> not be married or engaged to a person who is eligible to hold Australian or .ew Kealand citiFenship or permanent
resident status, at any stage of the application, selection, mobilisation processes or while on!scholarship in
Australia
> satisfy Australian 4overnment re/uirements for international student entry to Australia (health, character etc#
> not be applying for a visa to live in Australia
> not be applying for another long!term Australia Award unless they have resided outside Australia for twice the
length of the total time that they were in Australia (for e1ample, a previous Australia Awards Scholarship recipient
in Australia for four years will not be eligible to apply for another Australia Awards Scholarship until they have
resided outside Australia or back in $ndonesia for eight years#
> have satisfied any specific criteria established by $ndonesia or government of $ndonesia
> not be current serving military personnel
> be able to satisfy all re/uirements of the "epartment of $mmigration and :itiFenship ("$A:# for an AusA$" student
visa and
1
Aceh, .usa )enggara )imur, .usa )enggara Barat, Papua, 5est Papua
2
> be able to satisfy the admission re/uirements of the Australian university at which the Scholarship is to be
undertaken.
#P&"$.$"())/0 "(*$*(T&# +,#T-
> be applying for courses that fall within the areas of priority (see ,:hoosing a :ourse of Study- below#
> at the application closing date, be not older than >< years of age
> have a 4rade Point Average (4PA# of at least <.= on a scale of ma1imum >.? (<.6; for applicants from AusA$"
4eographic +ocus Areas# and an *nglish language proficiency of at least ;.? in $*H)S (;?? in paper!based )2*+H
or C3 in internet based )2*+H ! $B)#. )he $*H)S or )2*+H result must be current (no earlier than <?3<#. .o other
*nglish language test will be accepted (specifically the result from a TOEFL Prediction Test is not accepted#.
:ontact details of the *nglish language test centre must be provided for verification of test results.
> have a 4rade Point Average (4PA# of at least <.6; for recipients with a disability as declared on the ABS)8AH$A
A5A8"S S:H2HA8SH$PS application form.
> apply for a degree at a level higher than their current highest /ualification%
o already hold an undergraduate degree, if applying for a Easters
o already have a Easters, if applying for a "octorate
> if applying for a "octorate, applicants will be restricted to staff of universities, higher education institutions,
research institutes, key policy makers and targeted candidates in other agencies associated with AusA$" activities
> it is highly desirable for "octorate applicants to have a letter of support from an Australian university for their
proposed field of study
> answer all relevant /uestions on the application form
> be willing and available to undertake full!time (Eonday ! +riday ?L??!3C??# *nglish for Academic Purposes (*AP#
training in $ndonesia prior to studying in Australia, if offered a scholarship.
&hoosing a &ourse o# Study
:andidates are encouraged to apply to study courses which fall within AusA$"Ms priority areas (P"A#. )he P"A
relate directly to the strategic obDectives contained in the Australia and $ndonesia :ountry Strategy. An indicative
list of the areas for study follows.
(ustralia
$ndonesia
Partnership
Priority (reas
(P*()
#ustainable %ro1th and
&cono2ic +anage2ent
*e2ocracy Justice and
%ood %o3ernance
$n3esting in People #afety and Peace
*escription of
P*(
Ipro!ing econoic polic"
and anageent# reducing
constraints to growt$ in
in%rastructure and
producti!it"# and ipro!ing
natural resource
anageent# en!ironental
go!ernance and response to
cliate c$ange&
Strengt$ening t$e
capacit"# accounta'ilit"
and responsi!eness o%
legal# deocratic and
o!ersig$t institutions# and
ipro!ing local
go!ernent and pu'lic
%inancial anageent&
Better (ualit"# access
and go!ernance in
education# and 'etter
$ealt$ access and
s"stes
Ipro!ing responses to
$uanitarian needs#
eergencies and
!ulnera'ilit" to
disasters# and
ipro!ing capacit" to
ensure transport
securit" and to counter
t$reats %ro
transnational crie&
(ustralia
$ndonesia
Partnership
Priority .ields
of #tudy
.atural 8esource
Eanagement
Eining
Agriculture
A/uaculturefisheries
+orestry
:limate :hange
*conomics
$nfrastructure Planning
5ater and Sanitation
8ural 4rowth
Small and medium
enterprise
Haw, legal and
Dudicial systems
Political Science and
4overnment
Public administration
Public e1penditure
management
Public Sector
8eform
*nvironmental Haw
Anti!corruption
"ecentralisation
Eonitoring N
*valuation
:ommunicable
"isease Prevention
Health
Eanagement
Health Services
Eaternal and :hild
Health
5omen and
4ender Studies
"isability Services
Public Health
*ducation and
)raining
*ducation
Eanagement
Human 8esource
:hildhood Special
*ducation
:onflict 8esolution
"isaster
Prevention and
Eanagement
)ransport Safety
)ransnational
:rime Prevention
Studies
$nternational
Studies

.B% I% "our stud" area is not listed $ere# "ou a" still appl" %or a %ield o% stud" related to t$e work o% )us)I* in Indonesia& For ore in%oration
see t$e )ustralia Indonesia Partners$ip Countr" Strateg" at+ $ttp+,,www&ausaid&go!&au,Pu'lications,Pages,)ustralia-Indonesia-Partners$ip-Countr"-
Strateg"--../-01-englis$&asp2
:andidates considering study for particular professions should note that ABS)8AH$A A5A8"S S:H2HA8SH$PS
does not include the practical training period re/uired for professional registration, e.g. medical internships, legal
articles etc. Successful recipients are e1pected to complete such training in their own country.
Selection 'rocess
All applicants are considered by an independent 7oint Selection :ommittee comprised of Australian and
$ndonesian academics. 2nly those shortlisted will be interviewed. )he interview will assess candidatesM academic
ability, clarity of study goals, and cultural adaptability. A critical consideration will be how well the ABS)8AH$A
A5A8"S S:H2HA8SH$PS applicant is able to e1plain the relevance of their proposed study area to the
development of $ndonesia. )he interview will be accompanied by an $*H)S test of *nglish language proficiency.
+inal selection is obDective and based on the principles of merit and e/uity. )he final list of recipients is subDect to
scrutiny and endorsement by AusA$" and 4overnment of $ndonesia ! State Secretariat.

#&)&"T$O 4,OT(#-
> Bp to 6?J of awards will be offered to applicants from the )argeted :ategory including up to @?J of this number
from AusA$" 4eographic +ocus Areas
> At least @?J of awards will be offered to applicants from the .on!)argeted :ategory,
> L;J of awards at Easters level and up to 3;J of awards at "octorate (Ph"# level. (.B doctoral level study is only
open to staff of universities, higher education institutions, research institute, key policy makers and targeted
candidates in other organiFations associated with AusA$" activities#.
> an e/ual number of awards will be offered to men and women.
OT$.$"(T$O O. T5& #&)&"T$O '&#,)T
All applicants will be advised whether or not they have been selected for an interview. All interviewed applicants
will be notified whether or not they have been awarded an ABS)8AH$A A5A8"S S:H2HA8SH$PS. )he result is
final and no correspondence will be entered into. 5here appropriate, notification will include details of pre!
departure training (*nglish, academic skills, cultural preparation#. )his training is compulsory and full!time (see
page C for step by step of ABS)8AH$A A5A8"S S:H2HA8SH$PS Application Process#.
(e)uirements #or Scholarship (ecipients
Prior to tra3elling to (ustralia0 scholarship recipients 2ust-
> meet the minimum *nglish language re/uirement of their chosen Australian university (usually $*H)S of C.; with no
band less than C.?#
> at the completion of *AP training, candidates must achieve a minimum score of $*H)S C.? for ABS)8AH$A
A5A8"S S:H2HA8SH$PS office to commence the application process for placement in a university program in
Australia
> receive a letter of acceptance from an Australian university
> meet Australian immigration re/uirements for a student visa
> receive 4overnment of $ndonesia endorsement
> be medically fit to commence studies in Australia.

$n (ustralia0 scholarship recipients 2ust-
> abide by the conditions of the scholarship and the rules of Australian tertiary institutions
> abide by the rules and regulations governing a student visa
> act in a way that will not bring disrepute to AusA$", or to any Australian university or to $ndonesia
> return to $ndonesia for a period of two years at the completion of their studyresearch program in Australia. $f during
the two years e1clusion period the scholarship recipients return to Australia, a debt to the :ommonwealth may be
4
activated 28 any time spent in Australia may be added to the two year e1clusion period. :alculation of the two
years e1clusion period starts when the scholarships recipients arrive in $ndonesia, not the visa e1pire date.
*hat do Australia Awards Scholarships co+er,
> Pre-Course Englis$ & provision of *nglish for Academic Purposes training prior to commencement of studies in
Australia (including an in!$ndonesia stipend#
> In-Indonesia Stipend for the period from the commencement of Pre!:ourse *nglish to the date of recipient
mobilisation. )his does not apply to any deferral period.
> 3edical e2aination and 2-ra" costs in order to comply with Student Oisa re/uirements
> )us)I* Student 4isa and Student *ependant 4isa
> Outward )ir%are (economy! one way# from the airport closest to the recipientAs home location to the international
airport closest to the Australian university selected for study by the recipient
> O!erseas Student 5ealt$ Co!er 6OS5C7 ! recipient only (recipients are re/uired to maintain 2SH: for any
accompanying family in order to satisfy visa re/uirements#.
> Esta'lis$ent )llowance payable into the recipientAs bank account after arrival in Australia
> Contri'ution to Li!ing E2penses (in Australia Stipend# ! payment of a fortnightly contribution to living e1penses
(:H*#.
> Introductor" )cadeic Progra 6I)P7 for a period of >!C weeks undertaken prior to the commencement of Easters
or Ph" studies
> 3asters O8 P$* Tuition Fees & including all compulsory fees for the course in which the recipient is accepted into
> Suppleentar" )cadeic Support ! provided where it is deemed essential to assist recipients to pass course
subDects.
> Fieldwork ! holders of a scholarship where research comprises at least ;? percent of the program may receive a
return economy class airfare to $ndonesia to undertake essential fieldwork.
> 8eunion )ir%are ! is available to a IsingleA recipient after the successful completion of the first year of studyG
subse/uent reunion airfare entitlements will be available on an annual basis for the duration of the ABS)8AH$A
A5A8"S S:H2HA8SH$PS, e1cept for the final year of the ABS)8AH$A A5A8"S S:H2HA8SH$PS.
> 5oeward )ir%are (economy! one way# from the international airport closest to the Australian university selected
for study by the recipient to the airport closest to the recipientAs home location..

Family %ntry
8ecipients can bring their immediate families to Australia at their own cost, if their families meet AusA$" and
immigration re/uirements. +amilies are normally permitted to Doin eight (L# weeks after the recipientMs arrival.
-
.se#ul we!sites
(ustralia (1ards% http%australiaawards.gov.au
(ustralia (1ards #cholarships% http%www.ausaid.gov.auscholar
(ustralia (1ards #cholarship ((,#T'()$( (6('*# #"5O)('#5$P#) $ndonesia%
http%www.australiaawardsindo.or.id
7isas & "epartment of $mmigration and :itiFenship% http%www.immi.gov.au
#tudying in (ustralia% http%www.studyinaustralia.gov.au
(ustralian &ducational $nstitutions and courses ! the "o22on1ealth 'egister of $nstitutions and "ourses
for
O3erseas #tudents ("'$"O#)- http%cricos.deewr.gov.au
$&)T#- http%www.ielts.org.au
TO&.)% |||p.||WWW.e|s.org||oel|
.ollo1 (ustralia (1ard #cholarships updates at %reg +oriarty 8*ubes(ustralia
The A.ST(A/IA A*A(0S S&12/A(S1I'S Application
'rocess
3
Step 1
App||car| serds corp|e|e
Au3TbAllA AwAb03
3Cl0lAb3lll3 app||ca||or
lorr |o
Aus|ra||a AWards 0ll|ce oy
19 July 2013.
Step 2
App||car| |s ro||l|ed ol
||e resu|| ol se|ec||or lor
|r|erv|eW oy
mid December 2013.
Step 3
App||car| se|ec|ed lor
|r|erv|eW rece|ves
|rlorra||or ol |r|erv|eW|
lFlT3 |es| da|e||oca||or.
Step 4
App||car| a||erds
|r|erv|eW ard lFlT3 |es|
|r January 2014.
Step 5
App||car| |s adv|sed ol
||e resu|| ol ||e|r Au3TbAllA
AwAb03 3Cl0lAb3lll3
app||ca||or oy February 2014.
Australia Awards Scholarships
2014 Intake Application Form
1. Personal details
lrov|de suppor||rg docurer|ary ev|derce ol your lu|| rare, da|e ol o|r||, gerder ard cour|ry ol
c|||zers||p. lor exarp|e, ||e |der||l|ca||or page ol your passpor| or o||er oll|c|a| |der||l|ca||or
docurer| |ssued oy your cour|ry ol c|||zers||p.
0ero|es rarda|ory l|e|d
A||ac| a recer|
passpor| s|ze p|o|o.
3 x 4 cr.
T|||e
|r |rs |s ||ss 0r
0||er(l|ease spec|ly)
0|ver rare
Fr|er your lar||y rare ard o||er rares as
s|oWr |r your 8|r|| Cer||l|ca|e, lasspor| or
o||er oll|c|a| |der||l|ca||or docurer|. ll you
|ave or|y ore rare, er|er || |r oo|| l|e|ds.
lar||y rares
0a|e ol o|r|| | | dd|rr|yyyy 0erder |a|e lera|e
l|ace ol o|r|| (3|a|e|prov|rce)
w||c| cour|ry are you ||v|rg |r roW?
lave you app||ed, or are you |r|erd|rg |o app|y, lor perrarer| res|dercy or
c|||zers||p |r Aus|ra||a or NeW Zea|ard?
es No
Na||ora| lder|||y Nuroer
(KTl No.)

lasspor| ro.
(prov|de |l you |ave a
passpor|).

lssue da|e | |
Fxp|ry da|e | |
4
2. Contact details
esidential address (l|ease c|ec| ||a| your cor|ac| de|a||s are correc|. T|e sc|o|ars||p app||ca||or |a|es severa| ror||s |o oe l|ra||sed. ll you
carro| oe cor|ac|ed, your app||ca||or W||| ro| proceed.)
Address ||re 1
Address ||re 2
Address ||re 3
ToWr|C||y
3|a|e|lrov|rce los|a| code (|l ary)
Cour|ry
!ailin" address(Pro#ide details only i$ t%is is di$$erent to your current residential address.&
Address ||re 1
Address ||re 2
Address ||re 3
ToWr|C||y
3|a|e|lrov|rce los|a| code (|l ary)
Cour|ry
P%one and email (Pro#ide at least one contact number.&
lore p|ore ro. wor| p|ore ro.
|oo||e ro. lax ro. (|l ary)
Fra|| 1
Fra|| 2
Current 'or( address (l|ease prov|de your currer| Wor| address W|ere you car a|so oe cor|ac|ed. ll you carro| oe cor|ac|ed, your app||ca||or
W||| ro| proceed.)
Address ||re 1
Address ||re 2
Address ||re 3
ToWr|C||y
3|a|e|lrov|rce los|a| code (|l ary)
Cour|ry
5
3. Spouse details)
ll you |ave deperdar|s (spouse ard|or c|||drer urder 18 years ol age), prov|de ||e|r de|a||s ever |l ||ey W||| ro|
accorpary you |o Aus|ra||a. No|e ||a| ||e sc|o|ars||p does ro| prov|de l|rarc|a| suppor| lor accorpary|rg deperdar|s.
ou car ge| |rlorra||or or your respors|o|||||es lor your spouse ard ary deperdar| c|||drer, s|ou|d ||ey ||ve W||| you |r
Aus|ra||a dur|rg your sc|o|ars||p, lror ||e 0epar|rer| ol lrr|gra||or ard C|||zers||p (0lAC) or oy cor|ac||rg ||e
ur|vers||y W|ere you War| |o s|udy.
0|ver rare
lrov|de lar||y rare ard o||er rares as s|oWr |r your spouse's
o|r|| cer||l|ca|e, passpor| or o||er oll|c|a| |der||l|ca||or docurer|
lar||y rares
0a|e ol o|r|| | | dd|rr|yyyy 0erder |a|e lera|e
lasspor| ro.
Provide if spouse
has a passport.*

lssue da|e | |
Fxp|ry 0a|e | |
Cour|ry ol
c|||zers||p

w||| your spouse accorpary you |o Aus|ra||a? es No
4. C%ildren details *attac% a separate list i$ t%ere is not enou"% space&
lrov|de de|a||s ol ary deperder| c|||drer ard |rd|ca|e |l ||ey W||| jo|r you |r Aus|ra||a.
A deperder| c|||d |s ||e c|||d or s|epc|||d, ol yourse|l or your spouse, W|o |s ro| rarr|ed or ergaged |o oe rarr|ed ard
|as ro| |urred 18 years ol age.
N8. T||s 3c|o|ars||p does not prov|de l|rarc|a| suppor| lor lar||y reroers accorpary|rg you |o Aus|ra||a.
lrlorra||or or your respors|o|||||es lor ary c|||drer ||a| W||| ||ve W||| you |r Aus|ra||a dur|rg your sc|o|ars||p car oe
oo|a|red lror ||e Aus|ra||ar 0overrrer| 0epar|rer| ol lrr|gra||or ard C|||zers||p Weos||e or oy cor|ac||rg ||e
ur|vers||y W|ere you War| |o s|udy.
C%ild 1 'ill t%is c%ild accompany you to +ustralia,) -es .o
lar||y rare
0|ver rares
0a|e ol o|r|| | | dd|rr|yyyy 0erder |a|e lera|e
Cour|ry ol c|||zers||p
lasspor| ro.
Provide if child has a
passport.*

lssue da|e | |
Fxp|ry da|e | |
C%ild 2 'ill t%is c%ild accompany you to +ustralia,) -es .o
lar||y rare
0|ver rares
0a|e ol o|r|| | | dd|rr|yyyy 0erder |a|e lera|e
Cour|ry ol c|||zers||p
lasspor| ro.
Provide if child has a
passport.*

lssue da|e | |
Fxp|ry da|e | |
9
C%ildren details cor||rued
C%ild 3 'ill t%is c%ild accompany you to +ustralia,) -es .o
lar||y rare
0|ver rares
0a|e ol o|r|| | | dd|rr|yyyy 0erder |a|e lera|e
Cour|ry ol c|||zers||p
lasspor| ro.
Provide if child has a
passport.*

lssue da|e | |
Fxp|ry da|e | |
5. /mer"ency contact details)
lrov|de de|a||s ol a persor ||a| car oe cor|ac|ed |r case ol ar erergercy. T||s ray oe a re|a||ve or a lr|erd.
T|||e
|r |rs |s ||ss 0r
0||er l|ease spec|ly
lar||y rare
be|a||ors||p |o
you

0|ver rare 0erder |a|e lera|e
lore p|ore wor| p|ore
|oo||e p|ore lax (|l ary)
Fra|| 1
Fra|| 2
Address ||re 1
Address ||re 2
Address ||re 3
ToWr|C||y
3|a|e|lrov|rce los|a| code (|l ary)
Cour|ry
l|ease c|ec| ||a| ||e cor|ac| de|a||s are correc|
0. Pre#ious sc%olars%ips (a||ac| a separa|e ||s| |l ||ere |s ro| eroug| space)
0r|y |rc|ude de|a||s ol pos|-secordary sc|oo| sc|o|ars||ps or le||oWs||ps.
1a#e you pre#iously been a2arded a sc%olars%ip or a $ello2s%ip,) es No
1. Sc%olars%ip3$ello2s%ip title
3|ar| da|e Frd da|e Cour|ry
ua||l|ca||or (|l app||cao|e)
ur|vers||y
10
Pre#ious sc%olars%ips cor||rued
2. Sc%olars%ip3$ello2s%ip title
3|ar| 0a|e Frd da|e Cour|ry
ua||l|ca||or (|l app||cao|e)
ur|vers||y
4. Sc%olars%ip applications
1a#e you pre#iously applied $or an +us+5D sc%olars%ip but 2ere
unsuccess$ul,)
es No
ll es |oW rary ||res |ave you prev|ous|y app||ed lor Au3TbAllA AwAb03 3Cl0lAb3lll3?
1a#e you pre#iously been inter#ie2ed by +6S7+85+ +'+DS
SC198+S15PS,)
es No
ll 'es', |r W||c| years?
:. Disability
AusAID strongly encourages applications from people with disability who are otherwise eligible for a Scholarship. Under the Disability
Discrimination Act, Australian education institutions have to provide reasonable ad!ustments to students with disability to assist access to study.
"o assess the li#ely support needs, appropriate assistance, and the capacity of relevant institutions to provide the assistance, recipients with a
disability$special need must provide details of the disability and$or special need when they accept their offer. "his information is bound by
Australian privacy laws and will be disclosed only for the purpose of facilitating an accessible barrier%free learning environment.
&odifications to physical or learning environments, including additional educational supports such as sign interpreters and captioning, may be
available depending on the relevant Institutions capacity. AusAID will advise the Institution of any special re'uirements associated with a
(ecipient so that the Institution can pass these details to the Institution)s Disability *iaison +fficer prior to the (ecipient arriving on%campus.
,here an Institution is not able to provide the assistance re'uested, other Institutions may be recommended.
Do you identi$y as %a#in" a disability or do you 2or( in a disability;
$ocused or"anisation,)
neurological, learning disabilities, physical disfigurement, and the presence in the body of
disease%causing organisms
-http.$$www.hreoc.gov.au$disability/rights$dda/guide$who$who.html0
es No
ll yes, p|ease prov|de de|a||s |l you requ|re spec|a| ass|s|arce or equ|prer| |o par||c|pa|e |r ||e 3c|o|ars||p se|ec||or
processes or |o ||ve ard urder|a|e s|ud|es |r Aus|ra||a?

9. +re you applyin" $or an +6S7+85+ +'+DS SC198+S15PS as a public or open applicant, )
Public
ll `luo||c', p|ease |rd|ca|e |l your app||ca||or |s lror.
0overrrer| depar|rer|
3|a|e-oWred er|erpr|se
3|a|e ur|vers||y
9pen
ll `0per', p|ease |rd|ca|e |l your app||ca||or |s lror.
lr|va|e ur|vers||y
lr|va|e orgar|sa||or
lr|va|e |rd|v|dua|
10. Proposed study pro"ram)
11
AusAl0 W||| cors|der oller|rg you a sc|o|ars||p or|y |l your course ol s|udy W||| cor|r|ou|e |o ||e |org-|err reeds ol your
cour|ry. No|e ||a| ||e proposed prograr ol s|udy s|ou|d oe appropr|a|e |o your acader|c qua||l|ca||or ard Wor|
exper|erce.
e<uested 8e#el o$ study
-1ou will not be allowed to
upgrade your course from the
level at which you are first
placed0.
|as|ers
0oc|ora|e (l|0)
7ype o$ study) -&asters
coursewor# program can contain a
research pro!ect up to 234 of the
&asters. 5andidate decide the topic
during course0
CourseWor|
besearc|
Coro|ra||or
esearc% bac("round o$ Doctorate*P%D& candidates only=)
0o you |o|d a |as|ers degree W||| > 50 We|g|||rg lor researc|? -es .o
Are you |rc|ud|rg a |e||er lror your |as|ers superv|sor recorrerd|rg ||a| you s|ou|d pursue 0oc|ora|e
s|ud|es? (becorrerded) -es .o
Proposed $ield o$ study)
ou are requ|red |o.
lder||ly ||e lr|or||y 0eve|oprer| Area (l0A) lor your proposed s|ud|es. (l|ease ||c| ore oox or|y).
lder||ly ||e lr|or||y l|e|d ol 3|udy (ll3) lror ||e ||s| ol prelerred ll3 prov|ded (l|ease ||c| ore oox or|y).
ll recessary, you ray ror|ra|e aro||er l|e|d ol 3|udy |r 'o||er' (l|ease ||c| o||er ard prov|de de|a||).
+ustralia
5ndonesia
Partners%ip
Priority
+reas *PD+&)
Sustainable >ro2t%
and /conomic
!ana"ement
Democracy Justice
and >ood
>o#ernance
5n#estin" in People Sa$ety and Peace
Description
o$ PD+
Improving economic
policy and management,
reducing constraints to
growth in infrastructure
and productivity, and
improving natural
resource management,
environmental
governance and response
to climate change.
Strengthening the
capacity, accountability
and responsiveness of
legal, democratic and
oversight institutions, and
improving local
government and public
financial management.
6etter 'uality, access and
governance in education,
and better health access
and systems
Improving responses to
humanitarian needs,
emergencies and vulnerability
to disasters, and improving
capacity to ensure transport
security and to counter
threats from transnational
crime.
+ustralia
5ndonesia
Partners%ip
Priority
Fields o$
Study *PFS&)
Na|ura| besource
|aragerer|
||r|rg
Agr|cu||ure
Aquacu||ure|l|s|er|es
lores|ry
C||ra|e C|arge
Fcoror|cs
lrlras|ruc|ure
l|arr|rg
wa|er ard 3ar||a||or
bura| 0roW||
3ra|| ard red|ur
er|erpr|se
laW, |ega| ard jud|c|a|
sys|ers
lo||||ca| 3c|erce ard
0overrrer|
luo||c adr|r|s|ra||or
luo||c experd||ure
raragerer|
luo||c 3ec|or belorr
Frv|rorrer|a| laW
Ar||-corrup||or
0ecer|ra||sa||or
|or||or|rg &
Fva|ua||or
Corrur|cao|e
0|sease lrever||or
lea||| |aragerer|
lea||| 3erv|ces
|a|erra| ard C|||d
lea|||
worer ard 0erder
3|ud|es
0|sao||||y 3erv|ces
luo||c lea|||
Fduca||or ard
Tra|r|rg
Fduca||or
|aragerer|
lurar besource
C|||d|ood 3pec|a|
Fduca||or
Corl||c| beso|u||or
0|sas|er lrever||or ard
|aragerer|
Trarspor| 3ale|y
Trarsra||ora| Cr|re
lrever||or
3|ud|es
lr|erra||ora| 3|ud|es
0||er, please specify.
12
Proposed study pro"ram) cor||rued
lave you oo|a|red |rlorra||or lror ||e Au3TbAllA AwAb03 3Cl0lAb3lll3
lrlorra||or C0, or lror ||e Au3TbAllA AwAb03 3Cl0lAb3lll3 Weos||e
regard|rg s|udy op||ors |r Aus|ra||a?
es No
l|ease descr|oe ||e ellor|s you |ave urder|a|er so lar |o oo|a|r |rlorra||or or your s|udy op||ors |r Aus|ra||a.

+6S7+85+ +'+DS SC198+S15PS ; +ustralian 6ni#ersities 8ist
lo||oW|rg Aus|ra||ar ur|vers|||es are urder cor|rac| |o AusAl0 |o prov|de courses lor Au3TbAllA AwAb03
3Cl0lAb3lll3 rec|p|er|s. bec|p|er|s are
requ|red |o l|rd a su||ao|e course ol s|udy a| ore ol ||ese Aus|ra||ar ur|vers|||es. l|0 card|da|es rus| l|rd a superv|sor a|
ore ol ||ese ur|vers|||es. l|ease v|s|| ||e lo||oW|rg Weos||e lor rore de|a||s or Aus|ra||ar Fduca||ora| lrs|||u||ors ard
courses - CblC03. |||p.||cr|cos.deeWr.gov.au
Australian &aritime 5ollege
Australian 5atholic University
5arnegie &ellon University
5entral 7ueensland University
5harles Darwin University
5harles Sturt University
5urtin University of "echnology
Dea#in University
8dith 5owan University
9riffith University
:ames 5oo# University
*a "robe University
&ac'uarie University
&onash University
&urdoch University
7ueensland University of "echnology
(&I" University
Southern 5ross University
Swinburne University of "echnology
"he Australian ;ational University
"he <linders University of South Australia
"he University of Adelaide
"he University of &elbourne
"he University of 7ueensland
"he University of Sydney
"he University of ,estern Australia
U5* School of 8nergy and (esources
University of 6allarat
University of 5anberra
University of ;ewcastle
University of ;ew 8ngland
University of ;ew South ,ales
University of South Australia
University of Southern 7ueensland
University of "asmania
University of "echnology, Sydney
University of the Sunshine 5oast
University of ,estern Sydney
University of ,ollongong
=ictoria University
6ond University
"he University of ;otre Dame Australia
Proposed pre$erences
ll you are se|ec|ed lor ||e sc|o|ars||p ||e Aus|ra||a AWards 0ll|ce W||| lorWard your app||ca||or |o your preler Aus|ra||ar
ur|vers||y ard course ol s|udy. ou reed |o dec|de W||c| Aus|ra||ar ur|vers||y you War| |o a||erd ard c|oose ar
appropr|a|e course. ou s|ou|d c|oose |Wo courses ol s|udy. ou are ercouraged |o c|oose |Wo d|llerer| Aus|ra||ar
ur|vers|||es ra||er ||ar |Wo d|llerer| courses a| ||e sare ur|vers||y. ll your app||ca||or lor ||e l|rs| c|o|ce ol s|udy |s
ursuccesslu|, AusAl0 W||| lorWard your app||ca||or |o your secord c|o|ce. T|e CblC03 code lror your course car oe
lourd or ||e CorrorWea||| beg|s|er ol lrs|||u||ors ard Courses lor 0verseas 3|uder|s (CblC03) weos||e
|||p.||cr|cos.deeWr.gov.au
To l|rd ou| aoou| ||e cor|er| ol spec|l|c courses, you s|ou|d reler |o ||e |rd|v|dua| Aus|ra||ar ur|vers||y Weos||es. T||s
|rlorra||or car a|so oe lourd or ||e Au3TbAllA AwAb03 3Cl0lAb3lll3 lrlorra||or C0 W||c| car oe oo|a|red lror
||e Aus|ra||a AWards 0ll|ce or Au3TbAllA AwAb03 3Cl0lAb3lll3 Weos||e |||p.||WWW.aus|ra||aaWards|rdo.or.|d.
Pre$erence 1)

Course ||||e or par||cu|ar locus
area W||||r your |der||l|ed
proposed l|e|d ol 3|udy.
CblC03 code (|l app||cao|e)
Aus|ra||ar ur|vers||y
(|l app||cao|e)

Course dura||or (Wee|s)
(|l app||cao|e)

||r|rur Frg||s|
|arguage prol|c|ercy
requ|red lor ||e course
(lFlT3) (|l app||cao|e)

1
Proposed pre$erences cor||rued
Pre$erence 2)

Course ||||e or par||cu|ar locus
area W||||r your |der||l|ed
proposed l|e|d ol 3|udy.
CblC03 code (|l app||cao|e)
Aus|ra||ar ur|vers||y
(|l app||cao|e)

Course dura||or (Wee|s)
(|l app||cao|e)

||r|rur Frg||s|
|arguage prol|c|ercy
requ|red lor ||e course
(lFlT3) (|l app||cao|e)

A lorra| oller ol adr|ss|or W||| ro| oe requ|red |oWever || |s expec|ed ser|ous
l|0 card|da|es W||| |ave rade pre||r|rary erqu|r|es |o poss|o|e Aus|ra||ar
ur|vers|||es regard|rg ||e|r s|udy.
lave you d|scussed your proposed course W||| a reroer ol s|all lror ary
Aus|ra||ar ur|vers||y? T||s |s ||g||y recorrerded lor l|0 app||car|s. ll `es',
p|ease a||ac| ary re|evar| corresporderce W||| Aus|ra||ar ur|vers|||es.
es No
Are ||ere ary spec|a| suojec|s or s||||s ||a| you Wou|d |||e |o |rc|ude |r your
c|o|ce?
es No
ll es p|ease g|ve de|a||s. (No|e ||a| Au3TbAllA AwAb03 3Cl0lAb3lll3 does ro| |rc|ude ||e prac||ca| |ra|r|rg
per|od requ|red lor proless|ora| reg|s|ra||or, e.g. red|ca| |r|errs||p, |ega| ar||c|es e|c. App||car|s are expec|ed |o corp|e|e
suc| prac||ca| |ra|r|rg |r ||e|r oWr cour|ry).

14
esearc% proposal details
Corp|e|e |||s sec||or |l ||e s|ud|es W||| oe oy esearc% or a coro|ra||or ol esearc% and Course2or(. F.g. 0oc|ora|e
or |as|ers oy besearc|. 0||erW|se proceed |o rex| ques||or. ArsWers s|ou|d oe corc|se ou| sull|c|er| |o exp|a|r ||e
ra|ure ol your researc| proposa| |o ||e se|ec||or pare|. Please note 2ord limits. +nyt%in" o#er t%is limit 2ill not be
considered.
besearc| ||||e
-ma> ?@3 characters,
appro> 23% @3 words limit0

w|a| |s ||e oac|grourd |o
||e researc| oe|rg
proposed? -ma>imum A@3
words $ B A,333
characters0

lrov|de a besearc|
3|a|erer| (purpose ol
s|udy) |o accorpary ||e
proposed researc|. T||s
car |rc|ude a s|a|erer| or
W|a| |s spec|a| ard ur|que
aoou| ||e researc|?)
-ma>imum A33 words $ B
C33 characters0

w|a| |ypo||es|s are you
|es||rg |r your proposed
researc|? -ma>imum @3
words $ B 2@3 characters0

w|a| are ||e oojec||ves ol
||e proposed researc|?
-ma>imum ?33 words $ B
A,233 characters0

1-
esearc% proposal details
w|a| |s ||e
re||odo|ogy|s|ruc|ure |r
your proposed researc|?
(|rc|ude correr|s or
reasurerer|s, da|a
sources, re||ods ol
ara|ys|s ard ||re||res)
-ma>imum ?33 words $ B
A,233 characters0

lave you puo||s|ed ary
researc| |o da|e? (|rc|ude
|ex|s, jourra| ar||c|es -
prov|d|rg lu|| c||a||or)

w||c| ur|vers||y do you
cors|der appropr|a|e lor
your proposed s|ud|es?
w|y? -ma>imum @3
words $ B 2@3 characters0

lave you cors|dered a
poss|o|e researc|
superv|sor? w|y |||s
se|ec||orD-ma>imum @3
words $ B 2@3 characters0

w|a| |s ||e re|evarce ol
||e proposed researc| |o
lrdores|a?

0oes your proposed researc| |rc|ude l|e|dWor|? es No No| sure
ll `es' p|ease prov|de a descr|p||or ol ||e l|e|dWor| you W||| oe urder|a||rg. -&a> A333 characters, appro> ?33 words
limit0.

w|a| |s ||e dura||or ol your proposed l|e|dWor|? (|l |roWr) wee|s
lr W||c| cour|ry W||| you urder|a|e ||e proposed l|e|dWor|?
lroposed l|e|dWor| superv|sor (|l |roWr)
13
11. ?uali$ications)
8ist <uali$ications *2%et%er complete or not& by le#el o$ study@ startin" 2it% t%e %i"%est. ll you |ave ro| corp|e|ed
your s|ud|es p|ease ||s| your ar||c|pa|ed erd da|e. App||car|s are requ|red |o l||| ou| ||e |o|a| 0lA oo|a|red ard ||e
rax|rur 0lA poss|o|e lor eac| qua||l|ca||or ro|ed oe|oW.
0re cer||l|ed copy ol oll|c|a| |rarscr|p|s ard cer||l|ca|es |u3T oe |rc|uded W||| |||s app||ca||or. ll you are se|ec|ed lor
|r|erv|eW, you |u3T prov|de cer||l|ed Frg||s| |rars|a||ors W|er you a||erd ||e |r|erv|eW.
1. ?uali$ication name)
leve| ol s|udy
3ecordary (l|g| 3c|oo|) voca||ora|, Tec|r|ca|
( 0lll or 0lv )
urdergradua|e (31) los|gradua|e (32 or 33 )
Nare ol ur|vers||y
3|a|e|lrov|rce Cour|ry
larguage ol |rs|ruc||or 3|ar| da|e | |
0lA (|l app||cao|e) 0o|a|red | |ax

Frd da|e | |
3|a|us Corp|e|e lerd|rg resu||s lrcorp|e|e
2. ?uali$ication name)
leve| ol s|udy
3ecordary (l|g| 3c|oo|) voca||ora|, Tec|r|ca|
( 0lll or 0lv )
urdergradua|e (31) los|gradua|e (32 or 33 )
Nare ol ur|vers||y
3|a|e|lrov|rce Cour|ry
larguage ol |rs|ruc||or 3|ar| da|e | |
0lA (|l app||cao|e)
0o|a|red | |ax

Frd da|e | |
3|a|us Corp|e|e lerd|rg resu||s lrcorp|e|e
3. ?uali$ication name
leve| ol s|udy
3ecordary (l|g| 3c|oo|) voca||ora|, Tec|r|ca|
( 0lll or 0lv )
urdergradua|e (31) los|gradua|e (32 or 33 )
Nare ol ur|vers||y
3|a|e|lrov|rce Cour|ry
larguage ol |rs|ruc||or 3|ar| da|e | |
0lA (|l app||cao|e) 0o|a|red | |ax

Frd da|e | |
3|a|us Corp|e|e lerd|rg resu||s lrcorp|e|e
14
12. /n"lis% lan"ua"e pro$iciency)
App||car| rus| |ave ar Frg||s| |arguage prol|c|ercy ol a| |eas| 5.0 |r lFlT3 (or 500 |r paper-oased T0Fll or o1 |r
|r|erre|-oased T0Fll). T|e lFlT3 or T0Fll (lrs|||u||ora| or lr|erra||ora|) resu|| rus| oe currer| (a |es| resu|| oo|a|red |r
2012 or 2013 W||| oe cors|dered currer|). Ar or|g|ra| copy ol your lFlT3 or T0Fll cer||l|ca|e rus| oe a||ac|ed |o ||e
app||ca||or lorr. .9 o||er Frg||s| |arguage |es| (|rc|ud|rg T0Fll pred|c||or) resu|| W||| oe accep|ed.
5s /n"lis% your $irst lan"ua"e, es No
If E1es) go to ne>t section. If E;o) answer the following 'uestions.
'as /n"lis% t%e lan"ua"e o$ your %i"%est le#el o$ study, es No
If E1es), provide a statement from the university verifying the language of instruction.
1a#e you ta(en an 5/87S or 79/F8 test, es No
Tes| rare (e.g.
lFlT3 or T0Fll)

0a|e |es|
|a|er
$ $ 0vera||
score

Tes| Cer|re||oca||or l|ore weos||e
ll `No', W|er do you expec| |o corp|e|e ||e
|es|?
| | Tes| rare
13. Computer literacy)
l|ease arsWer ||e lo||oW|rg ques||ors |o ||e oes| ol your ao||||y. T||s W||| ass|s| Aus|ra||ar ur|vers|||es |o dec|de W|e||er
|o prov|de add|||ora| |u|||or.
+re you computer literate,) es No
1o2 re"ularly do you use a PC,) 0ccas|ora||y 0a||y wee||y |or|||y
Do you %a#e eAperience 2it% t%e $ollo2in" so$t2are,)
word process|rg sol|Ware
(e.g. word)?
es No
3preads|ee| sol|Ware (e.g.
Fxce|)?
es No
0a|aoase sol|Ware (e.g.
Access)?
es No
0pera||rg sys|ers (e.g.
w|rdoWs 2000)?
es No
lreser|a||or sol|Ware (e.g.
loWerlo|r|)?
es No
Fra|| sol|Ware (e.g.
0u||oo|)?
es No
lr|erre| oroWsers (e.g.
lr|erre| Fxp|orer)?
es No
3|a||s||ca| pac|ages (e.g.
3l33 or ||r||ao)?
es No
14. Computer trainin" details
l|s| ary lorra| corpu|er courses you |ave urder|a|er.
Course name 1
3|ar| da|e | | Frd da|e | |
Course name 2
3|ar| da|e | | Frd da|e | |
15. Current employment
Current employment ray |rc|ude Wor| exper|erce ard vo|ur|ary Wor|. l|ease er|er 'No| App||cao|e' |r ||e 'los|||or
T|||e' |l you are ro| currer||y erp|oyed. ou must prov|de a currer| Cv.
15
los|||or ||||e
0rgar|sa||or
leve| ol pos|||or |r
orgar|sa||or s|ruc|ure
-eg. 8chelon and 9olongan0
0a|e correrced | |
3ec|or|orgar|sa||or |ype 0overrrer||luo||c N00 |C|v|| 3oc|e|y lr|va|e
8r|el|y descr|oe ||e Wor| ol
your orgar|sa||or ard ||e
serv|ce || prov|des.

8r|el|y descr|oe your currer|
du||es ard respors|o|||||es
-ma> @33 characters, appro>
F3%A33 words limit0

Do you intend to return to t%is or"anisation a$ter your sc%olars%ip in +ustralia,) es No
ll 'es', W|a| ro|e ard
respors|o|||||es do you
expec| |o urder|a|e al|er
your acader|c s|ud|es?
-ma> @33 characters,
appro> F3%A33 words limit0

w|a| spec|l|c |as|s do you
ar||c|pa|e oe|rg ao|e |o
urder|a|e al|er your
acader|c s|ud|es? (spec|ly
a| |eas| 3) -ma> @33
characters, appro> F3%A33
words limit0

19
10. Pre#ious rele#ant employment
0r|y prov|de prev|ous erp|oyrer| ||a| |s rele#ant |o your app||ca||or. Frp|oyrer| ||s|ory s|ou|d a|so |rc|ude Wor|
exper|erce, corrur||y Wor| ard vo|ur|ary Wor|.
1. Pre#ious position
los|||or ||||e
0rgar|sa||or
3|ar| da|e | | Frd da|e | |
0u||es|respors|o|||||es
-ma> @33 characters,
appro> F3%A33 words limit0

2. Pre#ious position
los|||or ||||e
3|ar| da|e | | Frd da|e | |
0rgar|sa||or
0u||es|respors|o|||||es
(rax 500 c|arac|ers,
approx 100 Words ||r||)

14. 5nter#ie2 Centre )
l|ease ||c| your prelerred |r|erv|eW cer|er. (l|ease ro|e our c|o|ce |s ro| guarar|eed.)
Ja|ar|a
ogya|ar|a
3uraoaya
0erpasar
|edar|8arda Ace|
ladarg
8a|||papar|8arjarras|r
Jayapura
|a|assar
|arado
Kuparg
20
1:. Supportin" statement
l|r|| your arsWers |o 500 c|arac|ers, approx 80-100 Words, per ques||or. A||ac| a page |l ro| eroug| roor or |||s lorr.
Please note 2ord limits. +nyt%in" o#er t%is limit 2ill not be considered.
1. '%y do you 2ant to study in +ustralia,)

2. '%at s(ills and (no2led"e do you %ope to "ain and %o2 do you propose to use t%em,)

3. 1o2 %a#e you contributed to sol#in" a c%allen"e and to implementin" c%an"e or re$orm, *Be speci$ic and
include= 2%at aspect3s o$ your leaders%ip (no2led"e@ s(ills and practice you consider to be 2ell establis%ed and
e$$ecti#eC 2%ic% people or or"anisations you 2or(ed 2it% to sol#e t%e problemC and 2%at creati#e met%ods 2ere
used.&,)

21
Supportin" statement cor||rued
4. '%at speci$ic priority 2ill you contribute to on your return %ome and %o2 do you intend to do so,)

5. Do you currently %a#e any connection or relations%ip to any sta$$ employed at
+us+5D Posts or 2it% +us+5DDs mana"in" contractors,)
es No
If E1es) please e>pand.

0. +re you subEect to any criminal or ci#il proceedin"s t%at are currently a2aitin"
le"al action,)to li#e and underta(e studies in +ustralia,&
es No
If E1es) please e>pand. Please note information provided here will not necessarily dis'ualify you from submitting this scholarship application.

22
19. Pro$essional members%ips
lroless|ora| reroers||ps ray |rc|ude corrur||y, cu||ura|, po||||ca|, sc|er||l|c, proless|ora| ard|or educa||ora|
assoc|a||ors ard orgar|sa||ors.
1. 0rgar|sa||or Nare
l|g|es| pos|||or |e|d (|l ary)
3|ar| da|e | | Frd da|e | |
2. 0rgar|sa||or Nare
l|g|es| pos|||or |e|d (|l ary)
3|ar| da|e | | Frd da|e | |
3. 0rgar|sa||or Nare
l|g|es| pos|||or |e|d (|l ary)
3|ar| da|e | | Frd da|e | |
20. Communication)
'%ere did you $irst learn o$ t%e +ustralia +2ards Sc%olars%ips,
*tic( boA and speci$y 2%ere as(ed to do so&
AusAl0 sc|o|ars||p rec|p|er| Aus|ra||a AWards Weos||e
AusAl0 or |arag|rg
Cor|rac|or's 0ll|ce
lr|erd, re|a||ve or co||eague AusAl0 weos||e lore |rs|||u||or or ur|vers||y
Aus|ra||ar Froassy or
Aus|ra||ar Fduca||or Cer|re
(spec|ly |oca||or)
Aus|ra||ar |rs|||u||or or
ur|vers||y
(spec|ly)
luo||ca||or, bad|o, Tv
(spec|ly)

wor|p|ace or ror|ra||rg au||or||y
(spec|ly)
0||er
(spec|ly)

From 2%ere did you obtain your application $orm, *tic( boA and speci$y 2%ere as(ed to do so&
Au3TbAllA AwAb03
3Cl0lAb3lll3 Weos||e
Au3TbAllA AwAb03
3Cl0lAb3lll3 0ll|ce
AusAl0 0ll|ce
lr|erd, re|a||ve or co||eague 0ll3bTF 0ll|ce 0ol 3|a|e 3ecre|ar|a| 0ll|ce
Fduca||or Ager| (spec|ly)
lore |rs|||u||or or
ur|vers||y (spec|ly)
AusAl0 projec| oll|ce
(spec|ly)


wor|p|ace or ror|ra||rg
au||or||y (spec|ly)

Au3TbAllA AwAb03
3Cl0lAb3lll3
|rlorra||or C0-b0|

0||er (spec|ly)

2
21. C%ec(list o$ documentary e#idence)
l|ease ro|e. ou are respors|o|e lor prov|d|rg a|| suppor||rg docurer|s are prov|ded. ll you do ro| prov|de a|| requ|red
docurer|s your app||ca||or W||| oe rejec|ed.
9./ C9P- ol ||e corp|e|ed app||ca||or lorr.
+t least one copy ol ||e app||ca||or lorr s|ou|d |ave certi$ied) cop|es a||ac|ed ol ||e re|evar| docurer|s
||s|ed oe|oW.
w|ere or|g|ra| docurer|s are ro| |r Frg||s|, you rus| prov|de certi$ied) cop|es ol oll|c|a| Frg||s| |rars|a||ors
|l you are se|ec|ed lor ar |r|erv|eW.
* Certified. a statement that the document is a true copy, signed by a Commissioner of Oaths, Public Notary or other
formally recognised authority. If you are unsure about who is the appropriate person to certify your documents, you
should contact the AUS"(A*IA A,A(DS S5G+*A(SGIPS +ffice.
e<uired documentation. p|ease ||c| |l you |ave a||ac|ed ||e lo||oW|rg docurer|s |r suppor| ol your app||ca||or.
+ll applicants= */ssential&
ou |u3T |rc|ude all ||e esser||a| docurer|s. ll a| |eas| ore esser||a| docurer| |s ro| prov|ded, your app||ca||or W||| oe
au|ora||ca||y rejec|ed.
cop|es ol o|r|| cer||l|ca|e or equ|va|er| es N|A
prool c|||zers||p |.e. KTP or your passpor| persora| |rlorra||or pages es N|A
currer| Curr|cu|ur v||ae es N|A
oll|c|a| (certi$ied) & pos|-secordary ard |er||ary certi$icates3de"rees es N|A
oll|c|a| (certi$ied) & pos|-secordary ard |er||ary transcripts ol resu||s es N|A
currer| (ori"inal) 5/87S or 79/F8 Frg||s| |arguage |es| resu||s (a |es| resu|| oo|a|red
|r 2012 or 2013 W||| oe cors|dered currer|). 79/F8 prediction test is .97
accepted.
es N|A
|as|ers app||car|s rus| a|so a||ac| cer||l|ed 0lll degree cer||l|ca|e ard |rarscr|p| |l
us|rg 0lv or 31 ex|ers|or cer||l|ca|e||rarscr|p|
es N|A
0oc|ora|e app||car|s rus| a|so a||ac| cer||l|ed 31 degree cer||l|ca|e ard |rarscr|p| es N|A
acader|c relererce lror 32 superv|sor lor 0oc|ora|e card|da|es es N|A
0oc|ora|e ard ||ose |as|ers app||car|s W|ose s|udy W||| |rc|ude a| |eas| l|l|y percer|
researc| must l||| ||e researc| proposa| de|a||s or page 15 ol |||s app||ca||or lorr
es N|A
+dditional Documents= *9ptional&
App||car|s rus| prov|de ||e lo||oW|rg docurer|s |l ||ey are se|ec|ed lor ar |r|erv|eW.
recer| p|o|ograp| (3 x 4) es N|A
oll|c|a| (certi$ied) ) /n"lis% translations ol pos|-secordary ard |er||ary
cer||l|ca|es|degrees
es N|A
oll|c|a| (certi$ied) ) /n"lis% translations ol pos|-secordary ard |er||ary |rarscr|p|s ol
resu||s
es N|A
relererces lror 31 superv|sor lor |as|ers card|da|es (|l ava||ao|e) es N|A
||s| ol re|evar| puo||ca||ors, urpuo||s|ed ||eses (lor researc| app||car|s) es N|A
s|a|erer| lror ur|vers||y ||a| Frg||s| |s a |arguage ol |rs|ruc||or (|l app||cao|e) es N|A
re|evar| corresporderce W||| ar Aus|ra||ar ur|vers||y (|l ava||ao|e). es N|A
oll|c|a| (certi$ied) /n"lis% translations ol o|r|| cer||l|ca|e es N|A
5!P97+.7=
+ttac% only certi$ied copies o$ documents. D9 .97 attac% ori"inal documents.
+pplication $orms and documents 2ill not be returned.
24
22. Conditions o$ Sc%olars%ips
'+.5.>=
lr sec||or 22, 23 ard 24 you W||| oe agree|rg |o |rpor|ar| cord|||ors a||ac|ed |o your aWard ard your s|udy |r Aus|ra||a.
la||ure |o corp|y W||| ||ese cord|||ors W||| rear ||a| you ray |rcur a deo| |o ||e 0overrrer| ol Aus|ra||a ard your
sc|o|ars||p ray oe |err|ra|ed.
00 N0T s|gr ||e dec|ara||or a| ||e erd ol sec||or 23 ard 24 ur||| you lu||y urders|ard ||e cord|||ors ol ||e sc|o|ars||p
aWard. ll you |ave ary proo|ers urders|ard|rg 3ec||or 22, 23 ard 24 you are s|rorg|y adv|sed |o see| c|ar|l|ca||or ol
||ese cord|||ors lror ||e Aus|ra||a AWards 0ll|ce.
ll you are ollered a sc|o|ars||p you W||| oe as|ed |o agree |o cer|a|r cord|||ors oelore accep||rg ||e sc|o|ars||p. T|e ra|r
cord|||ors are se| ou| oe|oW lor your |rlorra||or.
lr accep||rg ar Aus|ra||a AWards 3c|o|ars||p, you W||| oe as|ed |o.
|a|e up ||e Au3TbAllA AwAb03 3Cl0lAb3lll3 |r ||e acader|c year lor W||c| || |s ollered,
corp|e|e a lu|| s|udy prograr dur|rg ||e course ol ||e|r sc|o|ars||p,
ro| |o|d aro||er Aus|ra||ar 0overrrer| sc|o|ars||p a| ||e sare ||re as ||e Au3TbAllA AwAb03
3Cl0lAb3lll3,
par||c|pa|e |r ||e lre-0epar|ure 8r|el|rg arrarged oy ||e los|, ard ||e ur|vers||y's corpu|sory lr|roduc|ory
Acader|c lrograr (lAl) or arr|va| |r Aus|ra||a,
res|de |r Aus|ra||a lor ||e dura||or ol ||e Au3TbAllA AwAb03 3Cl0lAb3lll3 (apar| lror |o||days, reur|or
v|s||s or l|e|dWor| v|s||s |o ||e|r |ore cour|ry),
corp|e|e ||e|r Au3TbAllA AwAb03 3Cl0lAb3lll3 aWard W||||r ||e per|od s||pu|a|ed |r ||e|r 3|uder|
Cor|rac|,
or|y urder|a|e ||e approved prograr lor W||c| ||e Au3TbAllA AwAb03 3Cl0lAb3lll3 |s ollered ard
ao|de oy ||e ru|es ol ||e ur|vers||y,
ra|r|a|r ar appropr|a|e s|udy |oad ard ac||eve sa||slac|ory acader|c progress |r ||e prograr lor W||c| ||e
Au3TbAllA AwAb03 3Cl0lAb3lll3 Was ollered,
par||c|pa|e |r a|| ac||v|||es assoc|a|ed W||| ||e approved course ol s|udy, |rc|ud|rg a|| |ec|ures ard |u|or|a|s,
suor|| a|| Wor| requ|red lor ||e course (e.g. ass|grrer|s or essays) ard s|| lor exar|ra||ors,
ro| urder|a|e ary add|||ora| oll-sc|o|ars||p |er||ary s|ud|es dur|rg ||e|r ||re |r Aus|ra||a or ar AusAl0 3|uder|
v|sa,
oe aWare ||a| ary erp|oyrer| urder|a|er dur|rg |err ||res ray corpror|se acader|c progress,
||a|se W||| ||e 3|uder| Cor|ac| 0ll|cer a| ||e ur|vers||y regard|rg ary proposed c|arges |o ||e approved
prograr ard ac|roW|edge ||a| approva| |s requ|red lror ||e ur|vers||y, AusAl0 ard lar|rer 0overrrer| oelore
ary c|arges are rade,
agree |o AusAl0 co||ec||rg |rlorra||or corcerr|rg ||e 3|uder| or deperdar|s ard pass|rg ||a| |rlorra||or or |o
o||er re|evar| par||es, |l recessary,
adv|se AusAl0 |rred|a|e|y, v|a ||e 3|uder| Cor|ac| 0ll|cer a| ||e ur|vers||y, |l ||ey rarry a persor W|o |s ar
Aus|ra||ar or NeW Zea|ard c|||zer, or W|o |as perrarer| res|derce s|a|us |r Aus|ra||a or NeW Zea|ard. T|e
c|arge |r a s|uder|'s rar||a| s|a|us ray allec| e||g|o||||y |o ra|r|a|r ||e Au3TbAllA AwAb03
3Cl0lAb3lll3, ard ||e 0eo| |o ||e CorrorWea||| ray app|y |l ||e s|uder| does ro| re|urr |o ||e|r |ore
cour|ry lor a per|od ol 2 years,
re|urr |o ||e|r cour|ry ol c|||zers||p lor |Wo years a| ||e corp|e||or ol ||e|r s|udy|researc| prograr |r Aus|ra||a,.
oe aWare ||a| a 0eo| |o ||e CorrorWea||| ol Aus|ra||a W||| oe |rcurred |l a 3|uder| la||s |o re|urr |o ||e|r |ore
cour|ry, or |l ||ey app|y lor lerrarer| bes|derce or lor a v|sa |o rera|r |r or re|urr |o Aus|ra||a W||||r ||e |Wo
year per|od, ard
||a| ary ||re sper| |r Aus|ra||a dur|rg ||e |Wo year re|urr |ore per|od W||| accord|rg|y ex|erd ||e erd da|e ol
||e |Wo year per|od,
agree ||a| ||e|r Au3TbAllA AwAb03 3Cl0lAb3lll3 ray oe |err|ra|ed a| ary ||re lor la||ure |o ra|e
sa||slac|ory acader|c progress, la||ure |o corp|y W||| ||e |aWs ol Aus|ra||a, r|scorduc|, oreac|es ol ||e cor|rac|
oe|Weer ||e 3|uder| ard ||e CorrorWea||| ol Aus|ra||a |rc|ud|rg oreac|es ol ||e cord|||ors ol ||e
2-
Au3TbAllA AwAb03 3Cl0lAb3lll3 or ol ||e AusAl0 3|uder| v|sa or |l ||ey app|y |o c|arge ||e|r v|sa
s|a|us.
Conditions o$ Sc%olars%ips cor||rued
3uojec| |o your lu|l||||rg ||ese cord|||ors AusAl0 W||| prov|de ||e lo||oW|rg, (e|||er d|rec||y or ||roug| ||e Aus|ra||ar
ur|vers||y).
Pre;Course /n"lis% - prov|s|or ol Frg||s| lor Acader|c lurposes |ra|r|rg pr|or |o corrercerer| ol s|ud|es |r
Aus|ra||a (|rc|ud|rg ar |r-lrdores|a s||perd)
5n;5ndonesia Stipend lor ||e per|od lror ||e corrercerer| ol lre-Course Frg||s| |o ||e da|e ol rec|p|er|
roo|||sa||or. T||s does ro| app|y |o ary delerra| per|od.
!edical eAamination ard A;ray costs |r order |o corp|y W||| 3|uder| v|sa requ|rerer|s
+us+5D Student Fisa ard Student Dependant Fisa
9ut2ard +ir$are (ecorory- ore Way) lror ||e a|rpor| c|oses| |o ||e rec|p|er|'s |ore |oca||or |o ||e |r|erra||ora|
23
a|rpor| c|oses| |o ||e Aus|ra||ar ur|vers||y se|ec|ed lor s|udy oy ||e rec|p|er|
9#erseas Student 1ealt% Co#er *9S1C& - rec|p|er| or|y (rec|p|er|s are requ|red |o ra|r|a|r 03lC lor ary
accorpary|rg lar||y |r order |o sa||sly v|sa requ|rerer|s).
/stablis%ment +llo2ance payao|e |r|o ||e rec|p|er|'s oar| accour| al|er arr|va| |r Aus|ra||a
Contribution to 8i#in" /Apenses *in +ustralia Stipend& - payrer| ol a lor|r|g|||y cor|r|ou||or |o ||v|rg
experses (ClF).
5ntroductory +cademic Pro"ram *5+P& lor a per|od ol 4-o Wee|s urder|a|er pr|or |o ||e corrercerer| ol
|as|ers or l|0 s|ud|es
!asters 0b P%D 7uition Fees - |rc|ud|rg a|| corpu|sory lees lor ||e course |r W||c| ||e rec|p|er| |s accep|ed
|r|o
Supplementary +cademic Support - prov|ded W|ere || |s deered esser||a| |o ass|s| rec|p|er|s |o pass course
suojec|s.
Field2or( - |o|ders ol a sc|o|ars||p W|ere researc| corpr|ses a| |eas| 50 percer| ol ||e prograr ray rece|ve a
re|urr ecorory c|ass a|rlare |o lrdores|a |o urder|a|e esser||a| l|e|dWor|.
eunion +ir$are - |s ava||ao|e |o a 's|rg|e' rec|p|er| al|er ||e successlu| corp|e||or ol ||e l|rs| year ol s|udy,
suosequer| reur|or a|rlare er||||erer|s W||| oe ava||ao|e or ar arrua| oas|s lor ||e dura||or ol ||e Au3TbAllA
AwAb03 3Cl0lAb3lll3, excep| lor ||e l|ra| year ol ||e Au3TbAllA AwAb03 3Cl0lAb3lll3.
1ome2ard +ir$are (ecorory- ore Way) lror ||e |r|erra||ora| a|rpor| c|oses| |o ||e Aus|ra||ar ur|vers||y
se|ec|ed lor s|udy oy ||e rec|p|er| |o ||e a|rpor| c|oses| |o ||e rec|p|er|'s |ore |oca||or.
our ur|vers||y W||| prov|de lor.
|rs|ruc||or ard lac|||||es recessary |o corp|e|e ||e spec|l|ed course
appropr|a|e acader|c ard We|lare suppor| lor ||e dura||or ol your s|ud|es
a|rpor| recep||or ard |erporary accorroda||or arrargerer|s or arr|va| |r Aus|ra||a.
23. .ominatin" +"ency Declaration ; re<uired $or Public sector applicants only)
(N8. |o oe corp|e|ed oy ||e s|all reroer W||||r your orgar|sa||or au||or|sed |o re|ease s|all lor overseas s|udy - lor
exarp|e s|all lror ||e lr|erra||ora| be|a||ors 8ureau (8KlN) | Cer|re lor Fduca||or ard Tra|r|rg | ||e l|arr|rg 8ureau |
bec|or lror ||e ur|vers||y as appropr|a|e. App||car|s lror ou|s|de Ja|ar|a rus| |ave ||e approva| ard ror|ra||or ol ||e|r
re|evar| Ka|arW|| or Kad|ras ard approva| lror 8upa|| or 0overror (or represer|a||ve) W|ere recessary.)
l|ease ro|e ||a| your s|gra|ure or |||s lorr s|gr|l|es your agreerer| |o ||e lo||oW|rg.
|o re|ease ||e app||car| lror Wor| du||es W|||e |e|s|e a||erds Frg||s| lor acader|c |ra|r|rg. T||s |ra|r|rg |s lu||-
||re ard corpu|sory
|o re|ease ||e app||car| lror Wor| du||es al|er Frg||s| lor acader|c |ra|r|rg |o s|udy |r Aus|ra||a, ard process
||e|r oll|c|a| passpor| ard ex|| perr||
|o cover ||e cos| ol |rave| |o ard lror Frg||s| lor Acader|c lurposes |ra|r|rg (8a|||Ja|ar|a)
|o cover ||e cos| ol |rave| |o ||e po|r| ol depar|ure (8a|||Ja|ar|a) pr|or |o |rave| |o Aus|ra||a |o cover ||e cos| ol
red|ca| exar|ra||ors lor ||e app||car|. A red|ca| exar|ra||or |s ar Aus|ra||ar lrr|gra||or requ|rerer| |o
rece|ve a s|uder| v|sa
|o se|ec| a l|e|d ol s|udy ard |eve| ol s|udy appropr|a|e |o ||e agercy's reeds.
l|ease a|so ro|e ||a| |l ||e app||ca||or |s lor 0oc|ora|e |eve| s|udy, ||e s|gra|ure oy ||e au||or|sed s|all reroer corl|rrs
||a| ||e app||car| |s a |ec|urer|researc|er||ey p|arrer or po||cy ra|er ard ||a| 0oc|ora|e |eve| s|ud|es are esser||a| lor
||s||er lu|ure researc| ard |or |eac||rg respors|o|||||es.
Nare ol ||r|s|ry|Frp|oyer
Nare ol App||car|
App||car|'s los|||or ||||e
24
App||car|'s leve| ol pos|||or
|r orgar|sa||or s|ruc|ure
-eg. 8chelon and 9olongan0
0a|e correrced | |
loW |org |ave you |roWr ||e app||car| ard
|r W|a| capac||y?

l|ease ra|e ary add|||ora| correr|s aoou|
||e app||car|'s po|er||a| or persora| qua||||es
W||c| you lee| Wou|d oe |e|plu| |o ||e
Au3TbAllA AwAb03 3Cl0lAb3lll3
3e|ec||or Tear.

!inistry3+"ency epresentati#e si"nature)
0r oe|a|l ol ||e r|r|s|ry, l ||e urders|gred, agree |o oe oourd |o ||e aoove corr||rer|s ard s|ra|eg|es
lu|| Nare 3|gra|ure & s|arp
los|||or

Fra||
|oo||e
0a|e | |
24. +pplicantDs aut%orisation@ a"reement@ declaration and si"nature)
25
+ut%orisation
AusAl0 rus| corp|y W||| ||e Privacy Act AHFF |r re|a||or |o ||e persora| |rlorra||or you |ave prov|ded |r |||s lorr.
8y suor||||rg |||s lorr l au||or|se AusAl0, or ||s appo|r|ed rarag|rg cor|rac|or, |o access ard|or oo|a|r |rlorra||or,
|rc|ud|rg cop|es ol ary ol ry re|evar| acader|c records|repor|s lror ||e Aus|ra||ar ur|vers||y(s) ||a| l |ave a||erded lor
||e lo||oW|rg purposes.
lor use |r ||e se|ec||or process lor ar Aus|ra||a AWard
|o ror||or ry acader|c perlorrarce a| ry |os| ur|vers||y W|||e s|udy|rg urder ar Aus|ra||a AWards
3c|o|ars||ps
|o or|el re|evar| Aus|ra||ar oll|c|a|s, ||r|s|ers ard reroers ol lar||arer|.
3|ou|d l rece|ve ar Aus|ra||a AWard, l corser| |o ||e Aus|ra||ar 0overrrer| us|rg ard d|sc|os|rg ex|rac|s ol ry
app||ca||or (re|a||rg |o ry acader|c oac|grourd ard ac||everer|s, |eaders||p s||||s ard ry proposed s|udy prograr |r
Aus|ra||a) |r proro||ora| ra|er|a| |r |ardcopy ard or ||e lr|erre|. l ro|e ||a| proro||ora| ra|er|a| ray |rc|ude, ou| |s ro|
||r||ed |o, red|a re|eases ard |rlorra||or c|rcu|a|ed |o AusAl0's olls|ore los|s ard Aus|ra||ar ur|vers|||es, corcerr|rg ||e
Aus|ra||a AWards 3c|o|ars||ps.
l au||or|se AusAl0 |o d|sc|ose ||e persora| |rlorra||or co||ec|ed |r |||s lorr |o o||er Aus|ra||ar 0overrrer| depar|rer|s
lor ||e purpose ol proro||rg ard rarag|rg ||e Aus|ra||a AWards 3c|o|ars||p.
6nderstandin"
l urders|ard ard corl|rr ||a|.
l |ave read ard corp||ed W||| ||e 3c|o|ars||ps lardooo| ard ||a| ||e cor|er|s ol ry app||ca||or are |rue ard
correc|
AusAl0 |as ||e r|g|| |o vary or reverse ary dec|s|or regard|rg ar Aus|ra||a AWards 3c|o|ars||ps rade or ||e
oas|s ol |rcorrec| or |rcorp|e|e |rlorra||or
0ec|s|ors ol ||e se|ec||or pare| are l|ra| ard corl|der||a| ard ro corresporderce aoou| ou|cores ol ||e
se|ec||or process W||| oe er|ered |r|o.
+"reement
ll successlu| |r ga|r|rg ar Aus|ra||a 3c|o|ars||ps, l agree ||a| l W|||.
urdergo a po||ce or c|arac|er c|ec| oelore ry Aus|ra||a AWards 3c|o|ars||ps |s corl|rred
|rred|a|e|y prov|de AusAl0 W||| de|a||s ol ary |rc|der| ||a| ray rel|ec| oad|y or ||e pres||ge ol ar Aus|ra||a
AWards 3c|o|ars||ps
ac| |r a rarrer oel||||rg a rec|p|er| ol ar Aus|ra||a AWards 3c|o|ars||ps
use ||e lurds lor ||e purposes grar|ed
ac|roW|edge ||e ass|s|arce g|ver oy ||e Aus|ra||ar 0overrrer| |r ary Wr|||er repor|s, puo||ca||ors or puo||c||y
assoc|a|ed W||| ||e 3c|o|ars||ps.
Declaration and ac(no2led"ement
l dec|are, |r suor||||rg |||s app||ca||or lorr, ||a| ||e |rlorra||or cor|a|red |r || ard prov|ded |r correc||or W||| || |s |rue
ard correc|.
5 ac(no2led"e t%at "i#in" $alse or misleadin" in$ormation is a serious o$$ence under t%e Criminal Code Act 1995
o$ t%e Common2ealt% o$ +ustralia.
lu|| Nare 3|gra|ure 0a|e

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25. !inistry o$ State Secretariat o$ t%e epublic o$ 5ndonesia use only
29
/ndorsement by t%e >o#ernment o$ 5ndonesia
( To oe corp|e|ed oy lead, 8ureau ol Tec|r|ca| Coopera||or, ||r|s|ry ol 3|a|e 3ecre|ar|a| ol ||e bepuo||c ol lrdores|a )
0r oe|a|l ol ||e 0overrrer| ol lrdores|a, l cer||ly ||a| l |ave exar|red ||e docurer|s a||ac|ed |o |||s lorr ard ar
sa||sl|ed ||a| ||ey are au||er||c ard re|a|e |o ||e app||car|.
l cer||ly ||a| ||e rax|rur |eve| ol s|udy, l|e|d ol s|udy ard |erg|| ol aWard proposed |r |||s app||ca||or are appropr|a|e
ard |r accordarce W||| ||e 0overrrer|'s |ra|r|rg po||cy.
l erdorse ||e app||car| lor ar Aus|ra||a AWards 3c|o|ars||p.
Nare ol cer||ly|rg oll|cer
T|||e
0rgar|sa||or
0ll|c|a| 3|arp 3|gra|ure 0a|e

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