Application for Bond University PhD Scholarship by wuxiangyu


									          Application for
         Bond University
         PhD Scholarship
                                                                                 CRICOS Provider Number 00017B

This application form is for all Australian and International higher degree research students who wish to apply for a PhD
scholarships in the advertised areas.
•   To be eligible for a PhD scholarship you are required to have an Australian bachelors degree with first class honours
    or an equivalent qualification
•   Please print clearly using BLOCK LETTERS and tick boxes where appropriate using a pen
•   Return your fully completed form with supporting documents to Bond University Graduate School of
    Research by 5 pm on Wednesday 30 November 2011
•   To assist you in completing this form please refer to the guidelines online

1        Prior contact with Bond University
Are you or have you been a student or staff member at Bond University?                   Yes            No
If yes, what is your Bond ID number:
If yes, what degree are you enrolled in?
2        Personal details
Title:    Mr        Ms          Mrs      Miss        Dr      Other:
Given names:
Family name:
Preferred name:
Country of birth:                                                 Citizenship:
Are you of Aboriginal or Torres Strait Islander decent, please select from the following:
 Aboriginal     Torres Strait Islander      Aboriginal and Torres Strait Islander       Unknown             No

Citizenship          Australian                                           Permanent Humanitarian Visa
or Visa:             Australian Permanent Resident                        Other temporary resident
                     New Zealand                                          International student or student visa
                    If you are not an Australian Citizen, please provide a copy of your visa with this application.
Date of birth:       /       /     (dd/mm/yy)                  Gender:      Male        Female
Mailing Address:
Country:                                                                     Post/Zip code:
Mobile phone:                                                                Facsimile: (       )
Home phone: (            )                                                   Work phone: (          )
Email address:
Permanent Address (Not a P.O. Box) if same as your mailing address please write ‘As Above’
Country:                                                             Post/Zip code:

Emergency           Name of next of kin:                                    Next of kin phone:
contact:            Next of kin address:                                    Relationship to applicant:

                            Sustainable Development                     Health Sciences and Medicine
                            Law                                           Urology
Field: Please
                            Counselling and Behaviour Management          Evidence Based Practice
indicate your               International Relations – China and           Population Health and Neuroimmunology
PhD area                     Western Relations                             Sports Health Science and Management
                                                                           Health Profession Education
3        Special requirements
Do you suffer from any condition – medical or otherwise, which will require Bond University to make special provision for
you, either academically or with regard to on-campus accommodation?
If yes, please provide specialist documentation with your application.           Yes          No
4       Research Proposal
Attach an outline of the research you propose to undertake, with a minimum of 500 words Including:
•   A statement defining the problem and significance to the field
•   A description of the methodology and of the facilities/resources required
•   A possible timetable for completion and
•   A statement certifying that the proposed research project does not incorporate work that has previously been
    submitted for the award of a degree or diploma
5       Previous education details
You must attach original or certified/witnessed copies of academic records for all tertiary studies completed or not
completed. Bond University Graduates are not required to provide Bond transcripts.
Completed degrees
      Name of Qualification         Institution          State or        Main field of    Full time or   Date studies      Date studies
                                                         Country            study          part time     commenced          completed

All incomplete degrees
        Name of Program                    Institution              Main field of study      Year        Full time or   Expected completion
                                                                                            started       part time       /withdrawal date

For any incomplete higher degree research programs (Doctoral or Research Masters) you were enrolled in at any time,
please provide the following:
Period of enrolment - Date from:       /     /                         Date to:     /      /
Reason for withdrawal:
If your date of withdrawal was less than three years ago, please attach evidence of this information.
6       Proficiency in English
The standard of English language proficiency requirements for higher degree research students is listed on
Failure to supply the documentary evidence requested may result in your application not being processed, or your
application for a scholarship being passed over. If you have not undertaken an IELTS or TOEFL test please make
immediate arrangements to do so and forward the result to Bond University. Your IELTS or TOEFL certificate cannot be
more than two years old.
Is English your first language?     Yes (go to section 8)              No (complete this section)
Were your tertiary level studies (within the last five years) conducted entirely in English?
   Yes (go to section 8) and attach an original statement confirming this from the university at which you studied
   No (complete this section)
Have you taken an English language proficiency test in the last two years?
   Yes attach the original certificate or certified /witnessed copy (go to section 8)
   No
7       Employment/professional qualifications/research experience
Attach a Curriculum Vitae (CV) specifying any experience relevant to the proposed program of study. Please ensure your
CV includes:
•   Dates and type of work/research in this field – chronological with the most recent date listed first
•   Any publications, with full citation details.
•   Unpublished reports of work you have compiled individually or in collaboration with others.
•   Current employment commitments including; employer, position, type of appointment e.g. full time part time, casual
    hours per week.
8       Personal statement
Please attach a personal statement of no more than 500 words to support your scholarship application. Please include
details of how this funding will assist you in completing the program in a timely fashion.
9       Academic referees
Please enter the details of two academic referees to whom you have forwarded the Academic Referee’s Report forms.
At least one referee should be a person under whose guidance you have studied. Referees should return their
completed reports to the Bond University Graduate School of Research by 30 November 2011.
Name of first referee:                                                      Institution:
Telephone:                                                                  Email:
Name of second referee:                                                     Institution:
Telephone:                                                                  Email:
10      Background information
Have you previously held any scholarship or award offered by Bond University or the Australian Government?
 No
 Yes – Name of award and dates held:
If your application is successful, will you also be in receipt of any other scholarship or award providing similar benefits?
 No
 Yes – Name of source and type of funding:
Have you applied for any other scholarship or award providing similar benefits, but the outcome is still pending?
 No
 Yes – Name of source and type of funding:
11      Declaration and signature
I declare that I have read the information provided on this form and the guidelines
and the information I have provided in respect of this application for a scholarship is correct in every respect. I
understand that I must advise Bond University of any changes to my personal circumstances that may alter my eligibility
for a scholarship. Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth) -

Signature:                                                                  Date:
Privacy collection statement
Bond University (BU) may collect personal information about you including the information on this form and information
on other forms or documents requested by and provided by you or other educational institutions to BU.
BU collects this information for the purpose of assessing your application and providing services to you.
 Unless you indicate that you do not wish BU to use your personal information for this particular purpose by
    placing a tick in the adjacent box, providing you with information about other services that BU offers that may be
    of interest to you:
         •    Facilitating BU’s internal business operations, including the fulfilment of any legal requirements;
         •    Analysing BU’s services and customer needs with a view to developing new and/or improved services; and
 Unless you indicate that you do not wish BU to use your personal information for this particular purpose by
    placing a tick in the adjacent box, providing you with promotional information about BU.
In the case of visa details, BU is required to collect this information pursuant to Australian immigration Laws.
BU may disclose personal information about you to:
•     Service providers who assist BU in operating its business, however these service providers are required to comply
      with BU’s privacy policy in how they handle your personal information;
•     A purchaser of the assets and operations of BU’s business, providing those assets and operations are purchased as
      an ongoing concern;
•     Its related entities
•     In the case of untrue or misleading information, Universities Australia (UA) or any UA member institution
•     In the case of an emergency involving you, your next of kin; and
•    Your agent, whose details appear on the front of this form, and/or your next of kin for the purpose of processing your
If the personal information you provide to BU is incomplete and/or inaccurate, BU may be unable to process this
application and/or be unable to provide you with the services you are seeking.
You may access the personal information BU holds about you in accordance with BU’s privacy policy available
Application checklist (all applicants must complete)
Please ensure the following documentation (where applicable) is attached to your application:

If you do not attach the appropriate documents, your application can not be considered.

A certified copy is a copy bearing the recognised mark of a Justice of the Peace, Commissioner of Oaths and
Declarations, Public Notary or a Solicitor.

    original or certified/witnessed evidence of Australia or New Zealand citizenship if applicable.

    original or certified/witnessed copy of passport and evidence of permanent resident status if applicable.

    certified/witnessed evidence of your visa

    certified copy of evidence of change of name, if applicable

    special requirements documentation, if applicable

    outline of your proposed research

    original or certified/witnessed academic transcripts from your previous tertiary study

    evidence of your period of enrolment from your previous tertiary institution where the Higher Degree
     Research degree was NOT completed

    original or certified/witnessed evidence of your English language proficiency

    Curriculum Vitae showing employment, qualifications and research experience

    your personal statement

    certified/ witnessed translation of any documents not in English

    any additional academic documentation that supports your claims

Please ensure you have contacted your academic referees.

    Referee’s report forms sent and requested them to return completed reports by mail to Bond University
     Graduate School of Research, Queensland 4229, Australia OR by email a PDF file of the original scanned
     report to Unsigned reports will NOT be accepted.

         Applications close at 5 pm on Wednesday 30 November 2011 and may be submitted by:

      Mail to : Bond University Graduate School of Research, Bond University, Qld 4229, Australia;
                                         Email to:

                                NO LATE APPLICATIONS WILL BE ACCEPTED

                                          Telephone : +61 755 954 197
                                           Email :

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