Endeavour Referee Report

2017
2016
Submitting Your
The selection process for theApplication
Endeavour Scholarships and Fellowships are merit-based and referee reports do not guarantee
an offer.
Please ensure that you have read the Endeavour Scholarships and Fellowships Applicant Guidelines available on the
Endeavour
Referee reports
websitereceived after the closing
before completing dateReturn
this form. will notyour
be considered.
application forms and the required supporting documentation to:
Reports returned directly
Endeavour Management Team to the department will be treated as confidential and will only be made available to the selection
panel and administrators.
Australian Government Department of Education and Training
Referees may be contacted by the selection panel during the selection process.

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International Group, GPO Box 9880
1. APPLICANTCanberra
DETAILS ACT 2601, AUSTRALIA
Incomplete or late applications will not be accepted
Title:
First Name: Last Name:
1. PERSONAL DETAILS

2. REFEREE

Title:

Application ID:
Gender:
(If known)
First Name:
Hiro
DETAILS

Preferred Name:
Title:
First Name:
Mr
Male

81 213 854 3719

Phone: +
(Mr, Miss, Ms or Mrs)

Female

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The Endeavour category the applicant is applying for:

Unspecified Date of Birth: 03/02/1982

Last Name: Suzuki

Former Name:
Last Name:
Cell/Mobile: + 81 213 865 5574
AM
Position Held: (Please include country and area codes) Organisation: (Please include country and area codes)

Email Address:
Phone: [email protected]
+ Mobile:
Alternate (Please include country and area codes)
Email Address:
[email protected]
Email:

Postal Address
EQUITY & DIVERSITY
Address Line 1:
Are you an Australian Aboriginal or Torres Strait Islander? (Australian applicants only)
Address Line 2:
Yes No Choose not to give
City/Suburb: State/Province:
Do you identify as an indigenous or first nations person of your home country ? (International applicants only)
EX

Postcode: Country:
Yes No Choose not to give
Relationship to applicant Length of relationship
Are you from a non-English speaking background?
Yes No Choose not to give Years
Language Japanese Months

3. APPLICANT
Do EVALUATION
you have a disability?
Please evaluate the applicant
Yes No against the criteria below, in Choose
terms ofnot
your experience.
to give Type
(Example: Top 5% = Excellent, Top 10% = Very Good, etc.)
Residential Address Postal Address (tick if same as residential) Unable to
(where you are currently living) Poor Average Good Very Good Excellent comment
Do not complete below if above box is ticked.
Academic/professional achievement
Address Line 1:
25-10-20 Higashiyama Address Line 1:
Leadership qualities
Address Line 2: Address Line 2:
Personal integrity
City/Suburb:
Sendai City City/Suburb:
Capacity to communicate and relate well to others
State/Province:
MiyagiResourcefulness
Prefecture and initiative State/Province:

Postcode:
980-0856 Postcode:
Emotional maturity
Country:
JapanAdaptability to new situations Country:

Potential for future contribution in field of study

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Endeavour Scholarships and Fellowships Application 2017
2. CITIZENSHIP AND RESIDENCY

Country of Citizenship Country of Permanent Residency

Japan Japan
Do you hold dual citizenship with another country(ies)?

No Yes Country(ies) Canada

In which country do you propose to undertake your Endeavour scholarship or fellowship?

Australia

3. PROPOSED PROGRAMME

Please indicate the Endeavour scholarship or fellowship you are applying for:

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1. Endeavour Postgraduate Scholarship (international) 4. Endeavour Executive Fellowship

Doctorate Degree (PhD) Professional Development

Masters Degree by Coursework

Masters Degree by Research

(international)

Diploma

Advanced Diploma

Associate Degree

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2. Endeavour Vocational Education & Training Scholarship
5. Endeavour Postgraduate Scholarship (Australian)

Long-term study/research towards an Australian Masters

Long-term study/research towards an Australian PhD

AM
3. Endeavour Research Fellowship
6. Endeavour QEII Diamond Jubilee Scholarship

Short-term postdoctoral research Long-term postdoctoral research

Short-term research towards a Masters Degree Long-term research towards a doctoral degree

Short-term research towards a Doctorate Degree

Please specify your proposed field of study, research or professional development.
e.g. education, engineering, environment, health, information technology, management

Engineering
EX

Proposed host organisation:

University of Sydney

Proposed Start Date:

01/02/2017 Proposed End Date: 01/06/2017

Home organisation Country of home organisation

Tohoku University Japan

Endeavour Postgraduate Scholarship (international) and Endeavour VET Scholarship applicants require one admission letter from an
Australian university.
Endeavour Research Fellowship (including QE II and Indigenous), Endeavour Executive Fellowship and Endeavour Postgraduate Scholarship
(Australian) applicants require a nomination form to be completed by their proposed host. Applicants can list up to three hosts.

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3. PROPOSED PROGRAMME (CONTINUED)

Please summarise, in words that can be understood by a person outside your field, details of your proposed programme, why you chose your
proposed host organisation and what your proposed programme is intended to achieve.
Also provide details, including proposed dates and locations of any proposed fieldwork and/or internships (maximum 300 words).

My proprosed programme will..........

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4. EDUCATIONAL QUALIFICATIONS

Please provide details of your educational qualifications:

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Please attach a separate list if you have completed more than three qualifications.
Qualification: PhD

Institution: Tohoku University

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Country of enrolment: Japan

Commencement date: 02/04/2014 Completion/Expected completion date* 02/04/2018

Study Status: Completed Undergoing

Qualification: Masters of Engineering

Institution: Simon Fraser University

Country of enrolment: Canada

Commencement date: 05/06/2010 Completion/Expected completion date* 07/06/2013

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Study Status: Completed Undergoing

*If an applicant has not completed an undergraduate degree but will complete by 31 December 2016, they must provide a letter from their
university to state when completion is expected. A condition will be placed on their application and a final transcript will be required if they are
successful in receiving a scholarship offer.

5. EVIDENCE OF ENROLMENT OR CONFERMENT

For Endeavour Research Fellowship, Endeavour Postgraduate Scholarship (Australian), Endeavour QEII Scholarship and Endeavour
Research Fellowship for Indigenous Australians applicants only.

I am currently enrolled in a Masters degree and will undertake research while on my Endeavour programme towards my Masters.
I am currently enrolled in a PhD degree and will undertake research while on my Endeavour programme towards my PhD.

I am currently enrolled in a PhD degree and will complete my PhD before I commence my Endeavour programme.

I have completed a PhD and will undertake postdoctoral research as my Endeavour programme.

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Endeavour Scholarships and Fellowships Application 2017
6. LANGUAGE REQUIREMENTS/PROFICIENCY

Endeavour Postgraduate Scholarship (International) and Vocational Educational Training Scholarship applicants must provide either (a) or (b):
(a) ELTS/TOEFL/CAE/PTE. A certified copy of an official, valid IELTS, TOEFL, CAE or PTE test result. Results are valid for two years.
Tests that are provided with a test date that is before 30 June 2014 will not be accepted and the application will be marked ineligible.
Test scores will need to meet the minimum requirements (see table below);
Test Type Requirements for all categories
IELTS Academic Test result ONLY Overall score of 6.5 with no individual band less than 6.0
TOEFL Paper Based Test (PBT) Score of 580 including a Test of Written English (TWE) score of 4.5
TOEFL Internet Based Test (IBT) Overall score of 79 with a minimum score of 21 in the writing section and no less than 19 in the other sections
CAE Cambridge English Advanced ONLY Overall score of 176 with no individual band less than 169
PTE Academic Test result ONLY Overall score of 58 with no individual band less than 50

(b)  transcript as evidence of completion of at least one year of undergraduate level study (minimum) conducted in English,face to face at an
a
institution located in one of the listed countries*

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 merican Samoa, Australia, Botswana, Canada, Fiji, Ghana, Guyana, Ireland, Jamaica, Kenya, Lesotho, Liberia, New Zealand, Nigeria,
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Papua New Guinea, Singapore, Solomon Islands, South Africa, Tonga, Trinidad and Tobago, United Kingdom (including Northern Ireland),
United States of America, Zambia or Zimbabwe.
* This list is determined by the Universities Admissions Centre (UAC) and is part of a collective agreement with Australian universities.
All Endeavour Research Fellowship, Endeavour Executive Fellowship and Endeavour Queen Elizabeth Diamond Jubilee Scholarship
applicants must provide:

7. SCHOLARSHIPS, AWARDS, MEMBERSHIPS AND PUBLICATIONS

1. Have you previously completed an Endeavour scholarship or fellowship?

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At least one completed nomination from their host organisation to undertake their programme in 2017
Your host organisation must confirm via the nomination form that your language ability is suitable for your proposed programme. If they do not
confirm this, you will be ineligible and your application will not be considered further.

Yes
2. Do you currently hold or have you completed, after 1 January 2015, an Australian Government administered scholarship and/or fellowship?

Yes No Commencement date Completion/Expected completion date

No
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3. Have you completed any other scholarship or awards? Yes No
4. Please provide details of relevant scholarships and awards, professional memberships and publications.
Please attach a separate list if you have additional scholarships, memberships or publications.
Scholarships/Awards

Scholarships/Awards Institution Country Year Awarded

University Medalist Hitotsubashi University Japan 2009

President's Scholarship Simon Fraser University Canada 2010
Merit Scholarship Hitotsubashi University Japan 2011
Memberships
EX

Membership Country Membership type

Engineers Without Boarders Japan Member

Hitotsubashi Engineers Society Japan Executive Member

Publications
Author(s): H. Suzuki

Publication title: A Guide to Modern Engineering

Publisher/Journal title: Engineers Monthly

Language of Publication: Japanese Year of Publication: 2010

Author(s): H. Suzuki, B. Ishida, H. Johnstone

Publication title: Advanced Theories in Modern Engineering

Publisher/Journal title: Engineers Digest

Language of Publication: English Year of Publication: 2014

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Endeavour Scholarships and Fellowships Application 2017
8. EMPLOYMENT HISTORY

Please provide details of relevant employment history beginning with your current or most recent employment.

Job Title Employer Name Country of Employment Start month and year End month and year

Senior Project Manager Ishida & Associates Pty Ltd Japan 02/2014 07/2016
Project Manager Ishida & Associates Pty Ltd Japan 03/2010 01/2014
Administrate Assistant New Design Engineering Canada 05/2008 11/2009

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9. REFEREES

Please provide details of two referees. It is your responsibility to ensure that referee reports are received by the Endeavour Management
Team by the closing date.

Title:

Organisation:

Email:

Title:
Ms First name:

[email protected]

Prof First name:

Rebecca
Ishida & Associates Pty Ltd

Tatsuke
PL Last name:

Position:

Phone: +

Last name:
Frost
Chief Engineer
81 323 122 3215
(Please include country and area codes)

Yamada
AM
Organisation: Hitotsubashi University Position: Dean, Department of Engineering

Email: [email protected] Phone: + 81 323 196 1347

(Please include country and area codes)

10. HOST NOMINATION

To be completed by Endeavour Executive Fellowship, QE II and Endeavour Research Fellowship (including Indigenous Fellowship)
applicants only.

Title: Mr First name: Michael Last name: Smith

EX

Organisation: The University of Sydney Position: Senior Researcher

Email: [email protected] Phone (Business): + 61 2 8435 9946
(Please include country and area codes)

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Endeavour Scholarships and Fellowships Application 2017
11. PROGRAMME SUPPORTING STATEMENT

Please provide details of how your proposed programme would further your academic and/or professional career (maximum 200 words).

My proposed programme will allow me to .....

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Please provide details of how your proposed programme will benefit Australia and your potential to foster ongoing collaboration and
cooperation with your home and host countries (maximum 200 words).

My proposed programme will foster ongoing collaboration by .....

12. PERSONAL STATEMENT

PL
AM
Please explain how receiving an Endeavour scholarship or fellowship would make a difference to your personal life (maximum 200 words).

I strongly believe that .....

EX

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13. SUPPORTING DOCUMENTS CHECKLIST

Please refer to the Applicant Guidelines to ensure that your supporting documents meet the scholarship and fellowship requirements.
To be eligible applicants must:
scan and attach their supporting documentation specified for the category for which they are applying (see table below and section
9.1-9.11). Applications that do not contain the necessary documentation will be deemed incomplete and therefore ineligible and will not
be considered further
provide an English translation if the original document is not in English
provide certified (attested) copies of:
- Passport, Birth Certificate, National ID card or Australian Citizenship Certificate
- Academic transcripts
- IELTS, TOEFL, CAE or PTE results.
To certify a document:
1. copy the original document

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2. p
 resent the photocopy and original to a professional person or someone well-respected in your community (of good standing). This could
include but is not limited to: university dean or course convener, teacher, work supervisor, lawyer, doctor, civil servant, Justice of the Peace,
Commissioner of Oaths or Public Notary.
the certifier will sight the original against the copy of the document
the certifier will write or use a stamp (if available), I certify that the copy is a true copy of the original document.

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the certifier will sign and date under the statement and provide details of their occupation
3. scan the certified copied document (not the original document).
4. attach the document to your application.
The cost of any fees charged by notaries for certification of documents is the responsibility of the applicant.

International applicants
Postgraduate (Masters and PhD)

Australian
applicants
AM Certified copy required

QEII and Research fellowship

Further details

Executive fellowship

Executive fellowship
Research fellowship

Postgraduate
Required documents
VET
EX

Passport or Birth Certificate or National ID card 3 9.1 3 3 3 3 3 3 3

Verification of Aboriginal and/or Torres Strait Islander 9.2 x x x x x 3* x
Academic transcript 3 9.3 3 3 3 3 3 3 3
Formal admission to an Australian institution for 2017 9.4 3 3 x x x x x
Enrolment letter(research towards Masters or PhD only) 9.5 x x x 3 x 3 3
PhD conferment (postdoctoral research only) 9.6 x x x 3 x 3 3
TOEFL, IELTS, CAE, PTE or Transcript 3 9.7 3 3 x x x x x
Employment record/cv/resume 9.8 x 3 3 x 3 x x
Referee reports x 2 9.9 3 3 3 3 3 3 3
Host nomination 9.10 x x 3 3 3 3 3
*Australian Indigenous and Torres Strait Islander applicants only

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Endeavour Scholarships and Fellowships Application 2017
14.PRIVACY AND PUBLICITY CONSENTS AND AGREEMENT

Privacy Act 1988 Applicants are not required to provide their consent to the collection and publication of
Materials as described in this Publicity Notice and may withdraw their consent at any
The Department of Education and Training (the department) and its contractors are time, prior to the publication of the Material, by contacting the department in writing at
bound by the provisions of the Privacy Act 1988 (Privacy Act). Schedule 1 of the [email protected].
Privacy Act outlines the Australian Privacy Principles (APPs), which prescribe the rules
for handling personal information, including sensitive information. Privacy and Publicity Consents and Agreement
Personal Information is defined by section 6 of the Privacy Act as: information or an By submitting an application:
opinion about an identified individual, or an individual who is reasonably identifiable
I consent to my Personal Information (including sensitive information) provided to,
:(a) whether the information or opinion is true or not, and(b) whether the information or
and collected by, the department in relation to applications under the Endeavour
opinion is recorded in a material form or not.
Scholarships and Fellowships being used for the Purposes and disclosed to the
The department collects Personal Information from applicants in order to assess their recipients as described in the Privacy Notice
applications and administer the Endeavour Scholarships and Fellowships. Applicants
I understand that the department will not provide individual feedback if my application
are not required to provide Personal Information to the department but without collecting
is unsuccessful. I will be provided with generic reasons why many of the Endeavour
Personal Information the department will not be able to process an application or
Scholarship Fellowship applications do not receive an offer via the Endeavour website
administer the Endeavour Scholarships and Fellowships for successful applicants.
at the conclusion of the round
The department will also collect Personal Information from successful applicants over
I understand that if my Personal Information is disclosed and/or published on the
the duration of their Endeavour Scholarship and Fellowship, including their image in
internet as described in this Privacy Notice:
photographs, film footage, images, and their words, quotes or other comments made by
or attributed to them, in so far as it relates to their participation in, and experience of, the my Personal Information will be available to the public on the world wide web and may

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Endeavour Scholarship and Fellowship. be viewed by members of the public in Australia and/or individuals or parties located
overseas;
Personal Information (including sensitive information) provided to the department by
applicants (including Personal Information collected by the department from successful - the department will have no control over who views my Personal Information
applicants over the duration of the Endeavour Scholarships and Fellowships) will only published on the internet or how a member of the public may use the Personal
be used by the department for the following purposes (the Purposes): Information;
a
 ssessing applications - Australian Privacy Principle 8.1 will not apply if the Personal Information is viewed or
used by an individual or parties located overseas; and
a
 dministering the Endeavour Scholarships and Fellowships
p

hardcopy and/or on the internet and

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 romoting the Endeavour Scholarship and Fellowships, including in promotional
material, photographs, audio visual, media releases, information and publications in

c ongratulating and/or inviting successful recipients and alumni to functions and events
held in Australia and overseas.
Please note, any Personal Information that is used in promotional materials and/or
published on the internet will be available to the public (including on the world-wide web)
and may be viewed by members of the public in Australia and/or individuals or parties
located overseas. The department will have no control over who views the Personal
Information published on the internet or how a member of the public may use the
Personal Information.
The department may disclose personal information in relation to applications under the
Endeavour Scholarships and Fellowships for the Purposes listed above to the following
-a
 n individual or parties located overseas will not be accountable under the Privacy
Act and as a result I will not be able to seek redress under the Privacy Act for any
privacy breaches committed by the individual or parties located overseas.
I agree that the Material may be used by the department for the purpose or promoting
the Endeavour Scholarship and Fellowships at any time in the future, even if
information about me in the Material (such as my employment status) has ceased to
be true
I understand and agree that I will not receive, and am not entitled to receive, any
payment for the use, disclosure or publication of the Material
I grant, to the extent (if any) that I own intellectual property rights in the Material or any
part of the Material, a perpetual, world-wide and royalty-free licence to the department
and its Agents to copy and disseminate the Materials in accordance with this Publicity
Notice
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recipients: I agree that the department:
Australian Government Departments and agencies, including but not limited to - is not obliged to, and has not represented to me that they will, publish the Material
Austrade, the Department of Foreign Affairs and Trade, the Department of Immigration
and Border Protection, the Australian Federal Police and the Department of Prime -d
 oes not have to identify me as author of any of the Material which they do publish or
Minister and Cabinet otherwise communicate and

Australian Parliamentarians and Parliamentary committees - may edit the Material prior to publication as it sees fit without first checking with me.

the departments contractors and agents By submitting an application, I understand and agree that if I am successful and accept
an Endeavour Scholarship or Fellowship:
Australian universities and participating Australian organisations and
I will provide the department, through Scope Global, regular reports on my progress
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 ther individuals or parties located overseas who may access Personal Information and a final report at the completion of my programme
published in promotional materials and/or on the internet.
I will act in a manner befitting a recipient of an Endeavour scholarship or fellowship
Applicants are not required to provide their consent to the collection, use and disclosure
of Personal Information as described in this Privacy Notice and may withdraw their I will use the funds for the purposes granted
consent in writing by contacting the department at [email protected]. I will acknowledge the assistance given by the Australian Government in any written
au. However, this will mean that the department may not be able to consider their reports, publications or publicity
application and/or administer and promote the Endeavour Scholarship and Fellowships.
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I will undergo a police check before my offer is confirmed (Australians only)

For information on the departments privacy policy, including information on how the
department handles personal information, how someone can access or correct personal I consent to the collection, use and disclosure of my Personal Information, in the
information, or how to make a complaint, go to www.education.gov.au/privacy or request manner described in the Privacy Notice for the duration of my Endeavour Scholarship
a copy of the privacy policy from [email protected]. and Fellowship

Publicity Notice I agree and consent to the publication of Material as described in the Publicity Notice

For the purpose of promoting the Endeavour Scholarships and Fellowship Program I have the right to withdraw my consent to the publication of the Material on the
(Program), the department may collect and publish images, photos, film footage, internet at any time prior to the publication of the Material, by contacting endeavour@
words, quotes or other comments made by or attributed to successful applicants, education.gov.au in writing.
and any other Personal Information about successful applicants (including sensitive Terms and Conditions
information), collected in connection with the Program (together, the Material). The
department may collect the Material during the term of the successful applicants I declare that I have read and understood the Privacy Notice above
Endeavour Scholarship and Fellowship, and use and publish the Material for the I declare that I have read and understood the Publicity Notice above
purpose of promoting the Program, at any time.
I declare that I have read and understood the Privacy and Publicity Consent and
The department may disclose the Material to any person or organisation, including Agreement Statement above
without limitation by publishing it:
I declare that the contents of my application are true, and
a
 s, or as part of, any book, newspaper advertisement or article
I acknowledge that giving false or misleading information is a serious offence under
television advertisement or programme the Criminal Code (Commonwealth).
r adio advertisement or programme and
o
 n the internet and in any other media.

Signature Date (dd/mm/yyyy)

Hiro Suzuki 09/06/2016 PRINT FORM

* By typing your name into this box, it is considered that you have signed this form and all the information is true and correct
(An electronic signature is not required).

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