Hardie Fellowship Application Form

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					                  This form is for use by Department of Education employees only

                                     Hardie Fellowship
                                     Application Form
                                                (Feb 2008)
                                     For Term 3, 2008 and in 2009
                                      Closing date: 30 June 2008

Full name: Mr / Mrs / Ms / Dr _____________________________________________________
Home postal address: ___________________________________________________________
 ___________________________________________________ Postcode: ________________
Telephone: (Home) _______________ (Work) ____________ (Mobile) __________________
School/Organisational unit: ________________________________________________________
Current teaching responsibilities:____________________________________________________
Teaching experience at start of 2008 (in years): _________________________________________
Promotion and experience level (if applicable): _________________________________________
Formal qualification intentions (if any): _______________________________________________

Referee Reports
Please forward two referee reports with this application. The Referee Report template is available
on the website http://www.education.tas.gov.au/school/educators/awards/hardie.
One of these will be the applicant’s Principal/Manager or Learning Services General Manager, and one
should be a ‘character referee’ with the ability to describe the particular personal qualities of the
applicant which would make them a suitable ambassador.

Summary of Fellowship Costs
Destination(s) if known: _______________________________________________________
Proposed length of Fellowship: __________________________________________________
Proposed approximate dates of Fellowship: _________________________________________

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Annual Base Salary (for calculation of salary ‘lump sum’ equivalent)                 $

Other approx. costs relating to your specific proposal - if known
(eg. Course fees, registration fees)

Applicant’s Signature: _____________________________________ Date: ______________

Please attach
     Statement of professional objectives (maximum 1 page)
     Curriculum Vitae
     Research or study proposal (maximum 5 pages)
     Two Referee Reports

(NB - Refer to the Selection Criteria in the Guidelines. Please number and attach pages together -
     do not staple or include folders of any kind.)

Applications should be sent to

The Project Officer
Hardie Fellowships
Centre for Extended Learning Opportunities (CELO)
PO Box 730

Applications close at 5.00 pm, Monday 30 June 2008 for Fellowships in Term 3, 2008 and in 2009.
Please note that no late applications will be accepted.

For further information about the Hardie Fellowships, contact the Project Officer on (03)6233 5181
or email: awardsandscholarships@education.tas.gov.au

 Personal Information Protection
 Applicant personal information will be collected from you for the purpose of obtaining and verifying staff details and
 will be used by the Centre for Extended Learning Opportunities (CELO) to assess staff eligibility for this award/
 Failure to provide this information may result in CELO being unable to process your application.
 Your personal information will be used for the primary purpose for which it is collected and may be disclosed to
 government and other authorised agencies for the purposes stated above.
 Personal information will be managed in accordance with the Personal Information Protection Act 2004 (the Act)
 from its commencement and may be accessed by the individual to whom it relates on request to the Manager
 Learning, Learning Services (South).
 You can obtain a copy of the Department’s Personal Information Protection Policy on request to Department of
 Education Information Services at http://www.education.tas.gov.au/dept/about/legislation/pip/policy.

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