. .

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The Application Form for an Australia Awards

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Scholarship 2023 Intake
Additional Information Form for Indonesian Applicants

Mandatory form complementing the OASIS online application

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Before completing this form, all applicants are required to apply online at: https://oasis.dfat.gov.au
and obtain your OASIS application ID. Failed to submit this form will result to application being
incomplete and cannot be processed.

Please read the following instruction before you complete or "Start Submission" on this Online Form.
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1. Read carefully the Australia Awards Scholarships Policy Handbook and Country’s (or Regional)
profile. Both documents are available on the DFAT website and at the Australia Awards in
Indonesia website.
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2. Read carefully all information about Australia Awards Scholarship on the Australia Awards in
Indonesia website (www.australiaawardsindonesia.org).
3. After completing the form, please download this completed form for your record.
4. This Online Form can only be accessed with a PC or Laptop. Completing the form using
Smartphone or Tablet is not recommended.
5. Complete all fields marked with an Asterix (*) including all the relevant sections.
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6. Complete the OASIS and this Additional Information Form in English.

7. If you need to preview the question, you can download the preview form from this link
8. For assistance, please email us at [email protected]

This form and all required documents listed on page 7 must be SUBMITTED by 29 April 2022 at 20:59
WIB.

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Do not send this form to universities or other parties outside Australia Awards in Indonesia.

Australia Awards Scholarships will be offered only to those whose course of study will contribute to the
long-term development needs of Indonesia. A list of the priorities is available under “Choosing a Course of
Study” on page 2 of this application form.

The list of Australian Universities participating in the Australia Awards Scholarship is available on DFAT’s
website and Australia Awards in Indonesia’s website. The information about Study Course is available on

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the participating universities’ websites or the Commonwealth Register of Institutions and Courses for
Overseas Students (CRICOS) website.

If you do not receive an invitation for an interview from the Australia Awards in Indonesia office by mid-

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August 2022, you should assume that your application has been unsuccessful.

In cases where information supplied by candidates is found to be inaccurate or incorrect, an award

offer may be revoked without notice.

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The closing date is 29 April 2022 at 20:59 WIB. To avoid busy online system, applicants are strongly
recommended to submit OASIS application and this form as early as possible. Please be advised that the
application system might experience significant traffic increase closer to the closing time.

General Information Notes

Australia’s international development assistance in Indonesia helps promote prosperity, reduce poverty,
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and enhance political stability.

Australia Awards Scholarships are prestigious international awards offered by the Australian Government
to the next generation of global leaders for development. Through study and research, recipients develop
the skills and knowledge to drive change and help build enduring people-to-people links with Australia.
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Applicants are assessed on their professional and personal qualities, academic competence and, most
importantly, their potential to impact development challenges in Indonesia.
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Applications are strongly encouraged from women, people with disability and other marginalised groups.

Level of study

Australia Awards Scholarships provide citizens of Indonesia with the opportunity to obtain a Master’s or
PhD/Doctorate degree from an Australian tertiary institution.
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Category

Australia Awards Scholarships in Indonesia are offered in two main categories: ‘Targeted’ and ‘Non-
targeted’.

Applicants from the Targeted category include:

1. Geographic focus areas (GFAs): any candidate working in one of the provinces/geographic focus
areas nominated under the GoA/GoI development partnership program. These are: Aceh, East

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 Nusa Tenggara, West Nusa Tenggara, Papua, West Papua, Maluku and North Maluku;
2. Government of Indonesia (GoI) agencies: any candidate from a government agency (including
central, provincial or local), but not extending to employees of state-owned enterprises or state
universities.

Applicants from Non-Targeted include candidates from the private sector, those that work for state
university and state-owned enterprise, and everyone else.

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Scholarships are for full-time study for a Master’s or Doctorate degree from Australian tertiary institutions.
The scholarship provides up to nine months full-time language and academic preparation in Indonesia.
Students must achieve satisfactory results in this training to be able to continue their scholarships.

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Social inclusion

Eligible candidates with disability or from organizations working with the disabled people are encouraged to

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apply. Women and candidates within DFAT Geographic Focus Areas are also encouraged to apply.

Supplementary programs

There is a number of supplementary programs associated with Australia Awards Scholarships in Indonesia
including the Allison Sudradjat Prize and Hadi Soesastro Prize.

Eligibility
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Australia Awards applicants must meet all eligibility requirements detailed in the Australia Awards
Scholarships Policy Handbook, available here.

Key requirements include:

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 be an Indonesian citizen and be residing in and applying for the scholarship from Indonesia;
 not be married or engaged to a person who is eligible to hold Australian or New Zealand citizenship
or permanent resident status, at any stage of the application, selection, mobilisation processes or
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while on-scholarship in Australia;

 satisfy Australian Government requirements 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 example, a previous Australia
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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 Indonesia for
eight years);
 have satisfied any specific criteria established by Indonesia or government of Indonesia;
 not be current serving military personnel;
 be able to satisfy all requirements of the Department of Immigration and Border Protection for a
DFAT student visa; and,
 be able to satisfy the admission requirements of the Australian university at which the Scholarship

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 is to be undertaken.

Specifically, candidates must:

 be applying for courses that fall within the areas of development priority (see “Priority Academic
Area of Study” below);
 have a Grade Point Average (GPA) of at least 2.9 from undergraduate if applying for a Master’s or

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from Master’s if applying for a Doctorate. For applicants from GFAs and other exceptional
candidates (to be determined by DFAT on a case-by-case basis, including people with disabilities),
have a GPA equal to or higher than 2.75;
 for Master’s applicants, have an English language proficiency of at least 5.5 in IELTS (or 525 in

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paper-based TOEFL or 69 in internet-based TOEFL or 46 in Pearson PTE). For applicants from
GFAs and other exceptional candidates (to be determined by DFAT on a case by case basis,
including people with disabilities) have IELTS 5.0 (or 500 in paper-based TOEFL or 59 in internet-
based TOEFL or 38 in Pearson PTE);

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 for PhD applicants, have an English language proficiency of at least 6.0 in IELTS (or 550 in paper-
based TOEFL or 79 in internet-based TOEFL or 54 in Pearson PTE);
 The IELTS or TOEFL or PTE result must be current (a test result obtained from 29 April 2020 until
29 April 2022 will be considered current). No other English language test (including TOEFL
prediction test) results will be accepted;
 provide contact details of test centre for verification of TOEFL test results;
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 already hold an undergraduate degree, if applying for a Master’s;
 already have a Masters, if applying for a Doctorate. Specialisation/professional certificate is not
considered a Master’s degree;
 answer all relevant questions on the application form; and,
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 be willing and available to undertake full-time (Monday - Friday from 8 am to 4 pm) English for
Academic Purposes (EAP) training in Indonesia prior to studying in Australia, if offered a
scholarship.
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Additionally:

 If applying for a Doctorate, applicants will be restricted to staff of universities, higher education
institutions, research institutes, key policymakers and targeted candidates in other agencies
associated with DFAT activities; and,
 It is highly desirable for Doctorate applicants to have a letter of support from an Australian
university for their proposed field of study.
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Choosing a Course of Study

Candidates must apply to study courses which fall within the following priority academic areas. An
indicative list of the areas for study follows. This list is subject to continuous review through the six-monthly
Program Coordination Committee process.

Australia Awards prioritises scholars seeking to undertake studies in support of the COVID-19
Development Response Plan priority areas, namely Health Security, Stability and Economic Recovery. A

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full list of priority fields is provided below.

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Candidates considering study for particular professions should note that Australia Awards Scholarships
does not include the practical training period required for professional registration, e.g. medical internships,
legal articles etc. Successful recipients are expected to complete such training in their own country.
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Selection Process

Applications will be shortlisted after eligibility checking, and only shortlisted candidates will be contacted.
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The selection process includes an interview and take into account the principles of merit and equity and
will be carried out jointly on behalf of the Australian and Indonesian Governments by an independent team
of Indonesian officials and academics working in partnership with Australian academics to evaluate and
rank candidates.

The team members will all hold Doctoral degrees obtained in Australia or be Doctoral graduates with long-
term experience in the Australian university system.
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The process aims to identify candidates most likely to succeed in academic studies in an Australian course
who will then make a substantial contribution in Indonesia. Applicants will be assessed against the
following criteria:

1. Academic competence
2. Potential outcome, specifically the contribution to development outcomes in Indonesia

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 3. Professional and personal leadership attributes including relevant work experience.

Notification of the selection result

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 Australia Awards Scholarships. The
result is final, and no correspondence will be entered into. Where appropriate, notification will include
details of pre-departure training (English, academic skills, cultural preparation). This training is compulsory

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and full-time (see page 6 for step by step of Australia Awards Scholarships Application Process).

Pre-Departure Training (PDT) in-Indonesia

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DFAT will provide all scholarship recipients with PDT in Indonesia. The aim of PDT is to prepare students
for study in Australia.

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 The length of PDT will range from 5 weeks to 9 months depending on the level of English language
proficiency of the student. PDT training is conducted in Bali.
 PDT is compulsory and full-time for all Australia Awards Scholarships recipients.
 DFAT will provide recipients with a monthly living allowance while they attend PDT.
 DFAT will not provide additional PDT in Australia.
 Recipients who withdraw from Australia Awards Scholarships after commencing PDT, are required
to refund the stipend paid to the recipient from the commencement of PDT. Circumstances for
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withdrawal will be reviewed on a case by case basis.

Requirements for Scholarship Recipients

Prior to travelling to Australia, scholarship recipients must:

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 meet the minimum English language requirement of their chosen Australian university (usually
IELTS of 6.5 with no band less than 6.0);
 at the completion of PDT, achieve a minimum score of IELTS 6.5 (with no band less than 6.0) for
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Australia Awards Scholarships 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 requirements for a student visa;
 receive Government of Indonesia endorsement; and,
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 be medically fit to commence studies in Australia.

In Australia, scholarship recipients must:

 abide by the conditions of the scholarship and the rules of Australian tertiary institutions;
 abide by the rules and regulations governing a student visa; and,
 act in a way that will not bring disrepute to DFAT, or to any Australian university or to Indonesia.

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In addition, scholarship recipients must

 gain support from DFAT if seeking to return to Australia within the two-year exclusion period for
anything other than a short-term visa for up to three months. Visa applications for short-term visits
do not require DFAT’s approval;
 return to Indonesia for a period equivalent of twice the length of the study period in Australia,
before re-entering Australia on another Government of Australia funded scholarship; and,

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 if during the two years exclusion period the scholarship recipients return to Australia, a debt to the
Commonwealth may be activated OR any time spent in Australia may be added to the two-year
exclusion period.

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What do Australia Awards Scholarships cover?

 Pre Departure Training (PDT) – including provision of English for Academic Purposes training

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prior to commencement of studies in Australia;
 Domestic Return Airfare from the airport closest to the recipient’s home location to the airport
closest to Pre-departure Training centre in Indonesia;
 In-Indonesia PDT Stipend for the period of PDT;
 Medical examination and x-ray costs in order to comply with Student Visa requirements;
 DFAT Student Visa and Student Dependent Visa;

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Outward Airfare (economy- one way) from the airport closest to the recipient’s home location to
the international airport closest to the Australian university selected for study by the recipient;
 Overseas Student Health Cover (OSHC) - recipient only (recipients are required to maintain
OSHC for any accompanying family in order to satisfy visa requirements);
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 Establishment Allowance payable into the recipient’s bank account after arrival in Australia;
 Contribution to Living Expenses (in Australia Stipend) - payment of a fortnightly contribution to
living expenses (CLE);
 Introductory Academic Program (IAP) for a period of 4-6 weeks undertaken prior to the
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commencement of Master’s or PhD studies;

 Master’s or PhD Tuition Fees – including all compulsory fees for the course in which the recipient
is accepted into;
 Supplementary Academic Support - provided where it is deemed essential to assist recipients to
pass course subjects;
 Fieldwork - holders of a scholarship where research comprises at least 50 percent of the program
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may receive a return economy class airfare to Indonesia to undertake essential fieldwork;
 Reunion Airfare - is available to a ‘single’ recipient after the successful completion of the first year
of study; subsequent reunion airfare entitlements will be available on an annual basis for the
duration of the Australia Awards Scholarships, except for the final year of the Australia Awards
Scholarships; and,
 Homeward Airfare (economy- one way) from the international airport closest to the Australian
university selected for study by the recipient to the airport closest to the recipient’s home location.

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Family Entry

Recipients may bring their immediate families to Australia at their own cost, if their families meet DFAT and
immigration requirements. Families are normally permitted to join eight (8) weeks after the recipient's
arrival.

Useful websites

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 Australia Awards: http://australiaawards.gov.au/
 Australia Awards Scholarship Indonesia: http://www.australiaawardsindonesia.org
 DFAT: http://dfat.gov.au/pages/default.aspx

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 Visas – Department of Immigration and Border Protection: http://www.border.gov.au
 Studying in Australia: http://www.studyinaustralia.gov.au

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 CRICOS: http://cricos.education.gov.au
 IELTS: http://www.ielts.org
 TOEFL: http://www.ets.org/toefl
 PEARSON: http://www.pearsonpte.com
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The Australia Awards Scholarships Application Process

Step 1
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Applicant completes Australia Awards Scholarships application through https://oasis.dfat.gov.au/ and

this form by 29 April 2022 at 20:59 WIB.

Step 2
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Applicant is notified of the result of selection for interview by June 2022.

Step 3

Applicant selected for interview receives information of interview/IELTS test date/location.

Step 4
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Applicant attends interview and IELTS test in July 2022.

Step 5

Applicant is advised of the result of their Australia Awards Scholarships application by August 2022

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.

Personal details
Details given in this question must match your passport, birth certificate or other official

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identification documents.

Note: If you have only one name, enter it in both fields.

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* Denotes mandatory field

OASIS ID

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Fill with your ID from OASIS
Title First Name Last Name

Gender
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Date of birth Place of birth

Country of citizenship Citizenship ID (KTP)

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Note: You must be a citizen of one of the eligible

participating countries.
Address line as your ID Card (KTP)
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Note: write until sub-district.

District (KTP) Province
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Personal Email Mobile Phone

Alternate Email Alternate Mobile Phone

Scholarships Category
Are you applying for an Australia Awards Scholarship as a public or open applicant?

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 Public  Open

If “PUBLIC”, please indicate if your application is from:

 Government department  State-owned enterprise  State university

If “OPEN”, please indicate if your application is from:

 Private university  Private organisation  Private individual

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Proposed study
 Masters  Doctorate (PhD)

Type of study
 Coursework  Research  Combination

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Research background of Doctorate (PhD) candidates only:
Do you hold a Masters degree with > 50% weighting for research?

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 YES  NO

Are you enclosing a letter from your Masters supervisor recommending that you should pursue
Doctorate studies?
 YES  NO

Proposed field of study

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You are required to:

o Identify the Priority Development Area (PDA) for your proposed studies. (Please tick one
box only).
o Identify the Priority Field of Study (PFS) from the list of preferred PFS provided (Please tick
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one box only).

o If necessary, you may nominate another Field of Study in 'other' (Please fill in "other" and
provide details).
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Priority Development Areas (PDA)

 Health Security  Stability  Economic Recovery

Health Security
 Communicable Disease Prevention  Health Management
 Health Services  Maternal and Child Health
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 Public Health  Education and Training

 Education Management  Human Resource Development
 Development Studies  International Studies
 NONE

Stability
 Law, legal and judicial systems  Political Science and Government

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 Public administration  Public expenditure management
 Public Sector Reform  Environmental Law
 Anti-corruption  Decentralisation
 Monitoring and Evaluation  Transnational Crime Prevention
 Conflict Resolution  Women and Gender Studies
 Disability Services  Disaster Prevention and Management

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 Cyber Security  NONE

Economic Recovery
 Trade  Small and medium enterprise development

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 Economics  Infrastructure Planning
 Transport Safety  Water and Sanitation

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 Mining  Livestock management
 Animal Husbandry  Agriculture
 Aquaculture/fisheries  Forestry
 Natural Resource Management  Climate Change
 Rural Growth  NONE

Other, please specify

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Ten students will be selected for an Australia for ASEAN Scholarships, prestigious enhanced awards
announced to mark the Australia-ASEAN Comprehensive Strategic Partnership, and to advance the
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ASEAN Outlook on the Indo-Pacific (AOIP). This is available at Masters level only.
Selected students will also participate in an Indo-Pacific Emerging Leaders Program, which will provide a
range of learning, networking and development opportunities.

Are you considering applying for an Australia for ASEAN Scholarship?

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 Yes  No
Must have an English language proficiency of at least 6.5 in IELTS with no band less than 6.0 (or 575 in
paper based TOEFL or 90 in internet based TOEFL or 61 in PTE Academic). The IELTS, TOEFL or PTE
Academic result must be current (obtained in the last 2 years from the application closing date, or a test
result obtained between 30 April 2020 and 30 April 2022 will be considered current). No other English
language test (including TOEFL prediction test) results will be accepted.
If yes, please select a priority area of study for an Australia for ASEAN Scholarship:
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Information on priority areas of study is available on the ASEAN website

https://asean.org/speechandstatement/asean-outlook-on-the-indo-pacific/
Please describe the efforts you have undertaken so far to obtain information on your study options
in Australia.

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A formal offer of admission will not be required however it is expected serious PhD candidates will
have made preliminary inquiries to preferred Australian universities regarding their study.

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Have you discussed your proposed course with a member of staff from any Australian University
 YES  NO

Are there any special subjects or skills that you would like to include in your choice?

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 YES  NO

If "Yes" please give details.

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Note that Australia Awards Scholarships do not include the practical training period required for
professional registration, e.g. medical internship, legal articles, etc. Applicants are expected to complete
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such practical training in their own country.

Applicant Qualifications
List of qualifications (whether complete or not) by level of study.
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If you have not completed your studies please list your anticipated end date. One certified copy of any
complete or incomplete official transcripts, certificates and certified copies of English Language
translations must be included

Your Latest Level of study

 Postgraduate (S3)  Postgraduate (S2)  Undergraduate (S1)  Diploma IV
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Postgraduate S3
Level of study Status of your study
Postgraduate (S3)  Complete  Pending Result  Incomplete

Qualification Name

e,g Doctor of Philosophy

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Name of institution

State/Province Country

Language of instruction

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Obtained GPA Max GPA

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Education Start date Education End date

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Postgraduate S2
Level of study Status of your study
Postgraduate (S2)  Complete  Pending Result  Incomplete

Qualification Name
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e,g Master of Science
Name of institution
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State/Province Country
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Language of instruction

Obtained GPA Max GPA

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Education Start date Education End date

Undergraduate S1
Level of study Status of your study
Undergraduate (S1)  Complete  Pending Result  Incomplete

Qualification Name

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e,g Bachelor of Engineering
Name of institution

State/Province Country

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Language of instruction

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GPA Max GPA

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Education Start date Education End date

Did you completed a Diploma III before doing

your Undergraduate or Diploma IV?
 Yes  No
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Diploma III
Level of study Status of your study
Diploma III (D3)  Complete  Pending Result  Incomplete
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Qualification Name

Name of institution
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State/Province Country

Language of instruction
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GPA Max GPA

Education Start date Education End date

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Applicant Working Experience

Current Working Experience

Are you currently working?

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 Yes  No

Organisation/ Institution Categories

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Organisation/Institution name

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Position

Start Date

If you forgot the exact date then just enter 1st of January
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Address line

District Province
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Detail if Overseas
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Type name of city and country

Business Phone

Supporting statement
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DFAT 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
adjustments' to students with disability to assist access to study. To assess the likely support needs,
appropriate assistance, and the capacity of relevant institutions to provide the assistance, awardees with a
disability/special need must provide details of the disability and/or special need when they accept their
offer. This information is bound by Australian privacy laws and will be disclosed only for the purpose of
facilitating an accessible barrier-free learning environment.

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Modifications to physical or learning environments, including additional educational supports such as sign
interpreters and captioning, may be available depending on the relevant Institution's capacity. DFAT will
advise the Institution of any special requirements associated with an Awardee so that the Institution can
pass these details to the Institution’s Disability Liaison Officer prior to the Awardee arriving on-campus.
Where an Institution is not able to provide the assistance requested, other Institutions may be
recommended.

Do you identify as having a disability ?

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 YES  NO
Under Australian law, disability includes physical, intellectual, psychiatric, sensory, neurological, learning
disabilities, physical disfigurement, and the presence in the body of disease-causing organisms

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If yes, please provide details if you require special assistance or equipment to participate in the
scholarship selection processes or to live and undertake studies in Australia?

You can use the questions below to guide you :

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 Hearing and Speaking - to communicate with others do you require or use any specific assistance?
(For example, hearing aids, sign language interpreter, lip reading, other communication assistive
device or additional time.)
 Writing and Reading - to access information and communicate using written materials do you
require or use any specific assistance? (For example, large print, Braille, computer software (e.g.
Jaws), lap top/computer, someone to transcribe for you, or additional time.)

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If you use an assistive device, please tell us what kind of device it is and/or if you have ever used a
different type of device.
 Do you require any specific changes or adaptations to move around?
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Write your answer below :

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Where did you first learn of the Australia Awards Scholarship (AAS)?
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 AAS recipients  Friends, relatives or colleagues  Workplace or nominating

authority
 University or Educational  Scholarship promotional events  Australia Awards website
institution (http://australiaawards.gov.au)
 Australia Awards in Indonesia  Scholarship promotional website  Australian Embassy social
website or mailing list media
(www.australiaawardsindonesia.or
g)

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Preffered interview location :
 Banda Aceh  Jakarta  Yogyakarta
 Makassar  Kupang  Mataram
 Ambon  Surabaya

Documentary evidence

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Please note: You are responsible for providing all supporting documents. If you do not provide all
required documents your application will be rejected.

 Only file on "PDF" and"image" ( JPEG or JPG or PNG or BMP) format acepted by system

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 Maximum file can upload is 2 MB
 Use Filename Format as "Your full name_NAME OF THE DOCUMENT". example below

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o Full Name_BIRTH CERTIFICATE
o Full Name_PROOF CITIZENSHIP
o Full Name_CV
o Full Name_TRANSCRIPTS
o Full Name_ACADEMIC CERTIFICATE

 File or Documents without "Your full name" in the filename may be successfully uploaded, but
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COULD NOT be read and saved in our system and your application become ineligible.
 The application form should have certified* copies attached of the relevant documents listed
below.
 Where original documents are not in English, you must provide certified* copies of official English
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translations if you are SELECTED for an interview.

*Certified: a statement by an authorised person that the document has been sighted and the copy has
been sworn to be a true copy of the original. An authorised person is either the official records department
of the institution that originally issued the documents, an Australian overseas diplomatic mission.
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Certification by a Notary Public may also be accepted. For further details on document certification,
please refer to the Scholarships Policy Handbook.

Required Documents
Copies of birth certificate or equivalent
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Use Filename Format as "Your full name_NAME OF DOCUMENT"

Proof citizenship (KTP)
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Current Curriculum Vitae (CV)
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Certified Postgraduate (S2) Certificate
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Certified Postgraduate (S2) Transcript
Use Filename Format as "Your full name_NAME OF DOCUMENT"

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Certified Undergraduate (S1)/Diploma IV Certificate
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Certified Undergraduate (S1)/Diploma IV Transcript
Use Filename Format as "Your full name_NAME OF DOCUMENT"
DIII Degree Certificate
Use Filename Format as "Your full name_NAME OF DOCUMENT"

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D III Transcripts of result
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Current (original) IELTS or TOEFL English language test results
The IELTS or TOEFL or PTE result must be current (a test result obtained from 29 April 2020 until 29 April

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2022 will be considered current). No other English language test (including TOEFL prediction test) results
will be accepted. Use Filename Format as "Your full name_NAME OF DOCUMENT"
Academic reference from S2 supervisor for Doctorate candidates
Mandatory for Doctorate Applicants. Use Filename Format as "Your full name_NAME OF DOCUMENT"

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Nominating Agency Declaration - required for Public sector applicants only
Mandatory for Public sector applicants.Use Filename Format as "Your full name_NAME OF DOCUMENT"
Please Download Nominating Agency Declaration template

Additional Documents: (Optional)

Official (certified*) English translations of birth certificate (if available)
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Use Filename Format as "Your full name_NAME OF DOCUMENT"
Other Proof Citizenship (Passport)
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Official (certified) English translations of post-secondary and tertiary certificates/degrees
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Use Filename Format as "Your full name_NAME OF DOCUMENT"

Official (certified) English translations of post-secondary and tertiary transcripts of results
Use Filename Format as "Your full name_NAME OF DOCUMENT"
references from S1 supervisor for Masters candidates (if available)
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Use Filename Format as "Your full name_NAME OF DOCUMENT"

list of relevant publications, unpublished theses (for research applicants)
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Relevant correspondence with an Australian university (if available)
Use Filename Format as "Your full name_NAME OF DOCUMENT"
Others Document's
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Use Filename Format as "Your full name_NAME OF DOCUMENT"

APPLICANT’S AUTHORISATION, AGREEMENT, AND DECLARATION
Authorisation

DFAT must comply with the Privacy Act 1988 in relation to the personal information you have provided in
this form.

By submitting this form, I authorise DFAT, or its appointed managing contractor, to access and/or obtain

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information, including copies of any of my relevant academic records/reports from the education
institution(s) that I have attended for the following purposes:

 for use in the selection process for an Australia Award.

 to monitor my academic performance at my host institution while studying under an Australia
Award.
 to brief relevant Australian officials, Ministers and members of Parliament. Should I receive an

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Australia Award, I consent:

1. to the Australian Government using and disclosing extracts of my application (relating to my

academic background and achievements, leadership skills and my proposed study program in

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Australia) in promotional material in hardcopy and on the Internet. I note that promotional material
may include, but is not limited to, media releases and information circulated to DFAT’s offshore
Posts and Australian education institutions, concerning the Australia Awards.

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2. to my personal information and that of my family members and dependents, including sensitive
information as defined in the Privacy Act 1988, being collected, handled, used and disclosed by
and exchanged between DFAT, other government agencies including Australian immigration
authorities, Australian education institutions, partner organisations (including managing contractors
and sub-contractors), medical insurers, medical practitioners, case managers, the
3. home government (where applicable) and other parties, in the circumstances outlined, and for the
purposes indicated, in the Australia Awards Scholarships Policy Handbook as updated from time to
time.
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4. I authorise DFAT to disclose the personal information collected in this form to other Australian
Government departments and Australian education institutions for the purpose of promoting and
managing the Australia Awards.

Understanding
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I understand and confirm that:

 I have read and complied with the Scholarships Policy Handbook and that the contents of my
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application are true and correct

 DFAT has the right to vary or reverse any decision regarding a scholarship made on the basis of
incorrect or incomplete information
 Decisions of the selection panel are final and confidential and no correspondence about outcomes
of the selection process will be entered into.
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Agreement

If successful in gaining an Australia Award, I agree that I will:

 undergo a police or character check before my Australia Award is confirmed

 immediately provide DFAT with details of any incident that may reflect badly on the prestige of an
Australia Award
 act in a manner befitting a recipient of an Australia Award

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  use the funds for the purposes granted
 acknowledge the assistance given by the Australian Government in any written reports,
publications or publicity associated with the Award.

Declaration and acknowledgement

Full Name

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Declaration
 I declare, in submitting this application form, that the information contained in it and provided in

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connection with it is true and correct. I acknowledge that giving false or misleading information is a serious
offence under the Criminal Code Act 1995 of the Commonwealth of Australia.

Acknowledge

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 I acknowledge that giving false or misleading information is a serious offence under the Criminal Code
Act 1995 of the Commonwealth of Australia.
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