Agenda

Diterim€

Nomor Surat

anggel Surat

Asal Surat

. 7L4

.27 Ap(ilzolz

: 4OO/DJPPf .UKominf olO4l2OIz

: A6 AprillolZ: Sesditjen PPI

1 Biasa

2 Segera

3 Rahasia

3 Relerensi

KEMENTERIAN KOMUNIKASI DAN INFORMATIKA

DIREKTOMT JENDERAL PENYELENGGARAN POS DAN INFORMATIKA

DIREKTORAT TELEKOMUNIKASI KHUSUS, PENYIAMN PUBLIK DAN KEWAJIBAN UNIVERSAL

SURAT MASUK

Perihal : Penawaran program beasiswa

Diteruskan k€pada

- lrf,rraa fu cttl

- bul: adrt y4'htrui'raF

frlchhari

p| t r"r,not relsus Pernerintah

gEgaan

2 Kasubdit Telsus Non Pemerintah

3 KasuMit Layanan Khusus Penlaran

4 fasubdit Pelayamn Kewaiiban Universal

5 KasuMitPengembangan Infrastruktur

6 Kasubbag Tata Usaha

7 Sekrstariat

Jakarta, 2012

KEMENTERIAN KOMUNIKASI DAN INFORMATIKA RIDITIEN PENYELENGGARAAN POS DAN INFORMATIKAJL. Medan Merdeka Barat No. 9 Jakarta Pusat Telp.\A- 3842723

Drr.'Ietsu-l lrpt"U

Kepada YthDariPerihalTanggalLampiranTembusan

NOTADINA5Nomor : q)O / DIPPI.I / KOMINFO/4/2012

Para Direkur dilingkungan Ditjen PP1

Sekretaris Ditjen Penyelenggaraan Pos dan InformatikaPenawaran Program BeasiswaJp Aptr120121 (satu) berkas

Yth. Dirjen PPI, sebagai laporan

Bersama ini terlampir kami sampaikan surat dari Kementerian Sekretariat Negara

Nomor : B-4541lKemseureg/Setmen/KTlN/Kl.03.00/03 / 2012 tmggal 19 Marct 2012

perihal tawaran beasiswa pemerintah Australia untuk Program AusttalianDeaelopment Scholarship ( ADS ) ilan program Australian Leailerchips AwardScholnrship (ALAS ) .

Berkaitan dengan hal ini, mohon agar kiranya tawatan beasiswa tersebut dapat

dimanfaatkan sebaik-baiknya pada unit kerja Saudara.

Demikian karni sampaikan atas perhatiannya kami ucapkan terima kasih.

Sekretaris Ditien PPI

a $',lllg;ilfl1ff31l*,*sr DAN TNF'RMATTKA

\(67 BtRo KEIEGAWATAN DAN oRGANtsAst .. '

_-_y, m.,,i,,_i,4.marar*,"f?,./"r.*"a; ?^./.,.,a,*Kolllll N f o :1. lr'tedan werdeka Bamt 9, Jakafta 10110 Tetp.(021) 3865189 Fax.(021) 3865189 www.depkominfo.go.id

N O T A DI N A SNomor: ltro /SJ.z/KOMt NFO/4/201 2

Kepada Yth : 1. para Sekretaris Diten, Badan dan ltien:2. Para Kepala Biro dan pusat di lingkungan Sekretariat Jenderal

: Kepala Biro Kepegawaian dan Organisasi: Penawaran Program Beasiswa pasca_S6rjana di Australia: 1 (satu) berkas: ?..{ Aptil2012

Tembusan Yth. : Bapak Sekretaris Jenderal (sebagai laporan);

Menindakranjuti Nota Dinas dari Kepara pusat Kerjasama Internasionar Nomor: 211isJ.7/KoMlNFo/3/2012 tanggal 30 Maret 2012 dan surat dari SekretarisKementerian sekretariat negara Nomor : 8-4541lKemsetneg/setmen/KTlN/KL.003.00/2012 tanggar 19 Maret 2012 tentang Tawaran Beasiswa pemerintahAustralia/ Program ADS, dengan hormat kami sampaikan bahwa pemerintahAustralia/ AusAlD menyediakan beasiswa untuk mengikuti pendidikan dalam bidang_bidang yang menjadi prioritas pembangunan nasionar dengan syarat dan ketentuansebagaimana terlampir.

Sehubungan dengan hal tersebut, bagi pegawai yang berminat dimohonuntuk segera menyampaikan pendaftaran dan persyaratan sebagaimana dimaksudke Biro Kepegawaian dan organisasi serambat-rambatnya pada tanggar 6 Agustus2012 yang kemudian akan diteruskan ke Kantor ADS Jakarta untuk proses rebihlanjut.

Demikian kami sampaikan, atas perhatiannya diucapkan terima kasih.

DariPerihal

LampiranTanggal

SRI CAHAYA KHOIRONI A

KOMINFO

KEMENIERIAN KOMUNIKASI DAN INFORMAIIKA RI

SEKRETARIAI JENDERAl

PUSAT KERJASAINA INTERNASIONAI. ime, ..*i.* m*-^o./r-l ?^1.'u,- +; ?,./.,."a';*d'//Jl. Merlan Merdeka Barat No. 9 Jakarta Telp. 021-3848104 F&i. 021-3500959 lYww.depkominfo.goid

NOTA - DINASNomor :2t -/SJ.7/KOMINFO/3i2012

Kepada YthDariPerihalTanggalTembusan Yth

Kepala Biro KepegawaianKepala Pusat Keriasama InternasionalTawaran beasiswa Pemerintah Australia/Program ADS

& Marc12D12

Menunjuk surat Sekretaris Kementerian Sekretariat Negara . No'

. B-

+sar/Kemseirieglsetmen/KTLNiKL.0o3.00/2012 tanggal 19 Marcr 2O12 perihal tersebut

ili"" i"rf "r"pir"fami

sampaikan tawaran beasiswa Femerintah AustraliaiProgram ADS

,.1i* oi""rp"ir-an tcepao'a unitunit kerja di lingkungan Kementerian Komunikasi dan

lnformatika.

TawaranbeasiswatersebutSekretarisKementerianSekretariatNegaramenghendaki dimanfaat sebaik-baiknya dan diharapkan nama-nama calon yang

,"rt"rr,i iyarat sudah disampaikan ke kantor ADS Jakarta di Gedung wirausaha

L."i"i i, Lr.'Hn Rasuna said Kav. C Kuningan Jakarta 12940 (Mr, Michael Bracher,

Program of Australia Awards - Jakarta).

Demikian disampaikan, atas kerjasamanya diucapkan terima kasih'

LAKHAR KEPALA PUSAT KERJASAMA INTERNASIONAL

NIP ; 196405251 984021001

Ylh ldiJakarta

KEMENTERIAN SEKRETARIAT NEGARAREPUBLIK INDONESIA

Nomor : B- 45ql /Kemsetneg/Setmen/KTlN/KL.03.0010312012Sifat : SegeraLampiran : Formulir aplikasi ADSH a I : ifawaran beasiswa Pemerintah Australia/

Program ADS

Jakarta, re Maret 2b12

Daftar terlampir )

Dengan hormat kami sampaikan bahwa untuk tahun akademik 201212013, PemerintahAustralia/AusAlD menyediakan 450 beasiswa Australian Development Scholarship (ADS) dan25 beasiswa Australian Leaderships Award Scholarship (ALAS), untuk mengikuti pendidikanprogram pasca-sarjana (Master dan Doktor) di Australia. Beasiswa yang ditawarkan adalahuntuk mengikuti pendidikan dalam bidang-bidang yang menjadi prioritas pembangunannasional pada universitas-universitas di Australia sebagaimana tercantum dalam Generallnformation Noles (pada halaman depan) dan forrnulir aplikasi ADS terlampir (halaman 13).

Tawaran beasiswa tersebut hendaknya dapat dimanfaatkan sebaik-baiknya dan se-lanjutnya diharapkan lnstansi Saudara dapat menyampaikan nama-nama calon yang me-menuhi persyaratan kepada Kantor ADS Jakarta di Gedung Wirausaha Lantai 7, Jalan H.R.Rasuna Said Kav.C-1 Kuningan, Jakarta 12940 (Mr. Michael Bracher, Program Manager ofAustralia Awards - Jakarta), selambat-lambatnya tanggal 17 Agustus 2012.

Untuk lebih jelashya-kami sampaikan informasi persyaratan program beasiswa ter-sebut di atas, sebagaimana tercantum dalam Austra/la n Development Scholarships 2013Intake Application Form.

Bagi para calon yang memenuhi persyaratan dan telah melengkapi dokumen-dokumen yang diperlukan akan diundang untuk mengikuti wawancara dan tes bahasa Inggris,yang waktu dan tempatnya akan diberitahukan kemudian.

Atas perhatian dan kerja sama yang baik, kami sampaikan terima kasih.

Kem enterian Sekretariat Negarabpala Biro Kerja Sama Teknik Luar Negeri,

UL'{."trdlV,S€

$rcBB/302

Jalan Veteran No. 17 - 18, Jakarta 10110 Telepon (021 ) 3845627 , 3442327

18.

1q

KEMENTERIAN SEKRETARIAT NEGARAREPUBLIK INDONESIA

Yth. :

1. Sekretaris. Kementerian Koordinator Bidang Politik, Hukum dan Keamanan2. Sekretaris Kementerian Koordinator Bidang Perekonomian3. Seikretaris Kementerian Koordinator Bidang Kesejahteraan Rakyat4. Sekretaris Kementerian Riset dan Teknologi5. Sekretaris Kementerian Koperasi dan Usaha Kecil dan Menengah6. Sekretaris Kementerian Pemberdayaan Perqmpuan dan Perlindungan Anak7. Sekretaris Kementerian Pendayagunaan Aparatur Negara dan Reformasi Birokrasi8. Sekretaris Kementerian Pembangunan Daerah Tertinggal9. Sekretaris Kementerian Badan Usaha Milik Neoara

',|0. Sekretaris Kementerian Perumahan Rakyat1 1 . Sekretaris Kementerian Pemuda dan Olah Raga12. Sekretaris Jenderal Kementerian Agama13. Sekretaris Jenderal Kementerian Pariwisata dan Ekonomi Kreatif14. Sekretaris Direktur Jenderal Kerjasama Industri Internasional, Kementerian Perindustria15. Sekretaris Jenderal Kementerian Dalam Negeri

u.p. Kepala Pusat Administrasi Kerjasama Luar Negeri16. Sekretaris Jenderal Kementerian Pertahanan

u.p. Kepala Biro Kerjasama Luar NegeriSekretaris Jenderal Kementerian Hukum dan HAMu.p. Kepala Biro KepegawaianSekretaris Jenderal Kementerian Energi dan Sumber Daya Mineralu.p. Kepala Biro Kepegawaian dan OrganisasiSekretaris Jenderal Kementerian Pertanianu.p. Kepala Pusat Kerjasama Luar NegeriSekretaris Jenderal Kementerian Kehutananu.p. kbpata Pusai K'erjaiamb Luai NegeriSekretaris Jenderal Kementerian Tenaga Kerja dan Transmigrasiu.p. Kepala Pusat Administrasi Kerjasama Luar NegeriSekretaris Jenderal Kementerian Pekerjaan Umumu.p. Kepala Biro Perencanaan dan Kerjasama Luar NegeriSekretaris Jenderal Kementerian Kesehatanu.p. Kepala Pusat Kerjasama Luar NegeriSekretaris Jenderal Kementerian Pendidikan dan Kebudayaanu.p. Kepala Biro Perencapaan dan Kerja Sama Luar NegeriSekretaris Jenderal Kementerian Komunikasi dan Informatikau.p. Kepala Biro Hukum dan KLNKepala Arsip NasionalKeDala Perpustakaan NasionalSekretaris Utama Badan Pertanahan NasionalSekretaris Utama Badan Standardisasi NasionalSekretaris Utama Badan Meteorologi Klimatologi dan Geofisika

31 . Sekretaris Utama..... ..

Jalan Veteran No. 17 - 18, Jakarta 10110 Telepon (021) 3845627,3442327

a/l

@zo-

zo.29.2n

WKEMENTERIAN SEKRETARIAT NEGARA

REPUBLIK INDONESIA

31. Sekretaris Utama Badan Koordinasi Survei dan pemetaan Nasional32. Sekretaris Utama Badan Pengawasan Keuangan dan pembangunan33. Sekretaris Utama Badan Nasional Penanggulangan Bencana34. Sekretaris Utama Lembaga Penerbangan dan Antariksa Nasional35. Sekretaris Pelaksana Harian Badan Nirkotika Nasional36. Sekretar:is NCB-lnterpol Indonesia, Markas Besar pOLRI37. Sekretaris Lembaga Administrasi Negara

Sekretaris Lembaga Sandi NegaraKepala Pusat Pelaporan dan Analisis Transaksi Keuangar,Kepala Badan Pengeinbangan SDM Perhubungan, Kementerian perhubunganKepala Badan Urusan Administrasi, Mahkamah AgungKepala Pusat Kebijakan Kerjasama Regional dan Bilateral, Badan Kebiiakan FiskKementerian KeuanganKepala Pusat Pendidikan dan Latihan, Badan Pengkajian dan Penerapan TeknologiKepala Pusat Pendidikan dan Pelatihan Kependudukan dan Ketuarga Berencana, Bad,

38.ao40.41.

Kependudukan dan Keluarga Berencana Nasional45. Kepala Pusat Pendidikan dan Latihan, Badan Pusat Statistik46. Kepala Biro Administrasi, Majelis Permusyawaratan Rakyat47. Kepala Biro Administrasi dan Kepegawaian, Dewan Perwakilan Rakyat48. Kepala Biro Perencanaan dan Keuangan, Dewan Perwakilan Daerah49. Kepala Biro Hukum dan Hubungan Luar Negeri, Kejaksaan Agung50. Kepala Biro Humas dan Protokol, Mahkamah Konstitusi51. Kepala Biro Kepegawaian, Badan Kepegawaian Negara52. Kepala Biro Kerjasama dan Pemasyarakatan lptek, Lembaga llmu Pengetahuan Indones53. Kepala Biro Kepegawaian dan Organisasi, Badan Urusan Logistik54. Kepala Biro Umum, Badan Koordinasi Penanaman Modal55. Kepala Biro Kerja Sama, Hukum dan Humas, Badan Tenaga Nuklir Nasional56. Kepala Biro Hukum dan Organisasi, Badan Pengawas Tenaga Nuklir57- Kepala Biro Perencanaan dan KLN, Badan Pengawas Obat dan Makanan58. Kepala Biro Sekretariat, Bank Indonesia59. Direktur SDM dan Umum, Lembaga Kantor Berita Nasional "Antara'

Jafan Veteran No. 17 - 18, Jakarta 10110 Telepon (021) 3845627,3442327

Australian Development Scholarshipszor3 Intake Application Form

InstructionsPl€ase print neatly using blqck letters (huruf cetak) and black ink

> Before completing lhis form, you must read the Australia Development Scholarships Handbook (The Handbook)

and your Country's profile, available on the AusAlD Website (see below) or from the AusAlD/Managing

Contractods office in Indonesia. Brief information about the program is also included in this application form. Also

see www.adsindonesia.or.id

> You must complete all fields marked with an * and all relevant sections.

> This apptication must be completed in English.

> For "Yes" or"No" questions, indicate your response with an'X'in the approprjate box'

> Three (3) copies of this form and of atl attached documents must be received by 17 August 2012 at the

lustrjtii Awards Office ai cedung Wirausaha, 7tn Floor. Jl. H.R. Rasuna Said Kav.C's

Kuningan, Jakarta {2940.

> DO NOT send this application to universities or other institutions in Australia'

> Australian Development scholarship6 wlll be offered only to those whose course of study wlll contribute

to the long-term development needs of Indonesia. A list of the development priorities is avaiiable under

"Choosing a Course of Study" on page 3 of this application form'

> AusAlD's website includes a list of Australian Universities that may receive Development Scholarship awardees.

course of study information is avallable directly from the universities' websites or the commonwealth Register of

lnstitutions and courses fof overseas students (cRlcos)website (see page 6 - UsefulWebsites).

> You may provide two preferences for courses of study. You should consider two Australian universities rather

than two courses at lhe same university, iust in case you do not meet the admissibiliv requirements of the first

Australian university.

> lf youf application is successful, you will be requked to sign a contract with the commonwealth of Australia and

be bound by conditions of the scholarship. A full list of the conditions is contained in this application form (page

25 - 26) anj in the Handbook. Please note that AusAlD reserves the dght to change these conditions at any time

> Submitting this application does not guarantee that you will receive a Scholarship'

> lf you do not receive an invitation to an interview from the Australia Awards office by mid-December, you should

assume that your application has been unsuccessful'

> Before applying, alt Public sector applicants are required to have section 23 of the form completed by the

relevant training or foreign cooperation bureau or lheir university rector (whichever is applicable).

> Applicants in the open category are not required to fill in section 23. Their applications are to be submitted

directly to the Australia Awards Office at the address above'

> Aoolicants must not fill in section 25. This section is for use by the Ministry of State Secretiariat of the Republic of

Indonesia (SetNeg) and refers only to selected candidates'

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

revoked without notice.

General fnformation Notes19E!ia Development Scholarships (ADS) provide opportunities for Indonesians to study in Australia atPOSTGMDUATE levet.

-U! !o lour hundred and seventy five scholarships are expectod to be awarded in 2013 for commencjment in2013/2014 including twenty five Australian Leadership Award Scholarships (ALAS). Candidates must undertake studyin one of the four areas of development priority (see page 3).

ADS are ofered in tvt/o main calegories: 'publlc Sector Category' and 'Open Categoqy'.

Public sector applicants are employees from Govemment organizations, state universities and state ownedenterprises. Their applications must be approved by training or foreign cooperation bureaus (BKLN) of their local orcentral agencies before being submitted to the ADS Program O{fice. Public sector candidates from govemmentagencies outside Jakarta may apply directy to the ADS Program Office with the approval oftheir relevant kakanwil orKadinas and approval ftom Bupali or Governor (or representative) where nec€ssary. Calon pegawai Negeri Sipilars not eligible to apply,

open Category applicants are from private organisations and universrues and this category is also open to recentuniversity graduates. No prior Government approval is rcquired for people apptying in the open iategory, andapplications are to be submifted direcily to the Austalia Awards Office. ihey require, where relevan! theendorsement of the agency, institution_or private-university in which the applicant is 'iorking or studying. Applicationsare submitted directly to the Australia Awards Office.

Public servants {PEgawai Neged) cannot apply in ihe Open category.

A third category fiargeted) eists for candidates who are identr'fied by their organisations in consultation with theADS Program. candidates within this category must be identified by their home organization and must not apply trothe ADS Program independently of their employ€r.'Targeted category' candidates are employed by organisations which are identified by the Government of Indonesraand Govemment of Australia (through AusAlD) as being strategicatly aligned with th; Development priorities of theGovernmentof Indonesia.

Sciolarships are for full-time study for a Masters or Doctorate degree from Australian tertjary institutions. Thescholarship provides up to nine months full-time language and academic preparation in Indonesia. Students mustachieve satisfactory results in this training to be able to continue their scholarshiDs.

ApPlications from people with disabilities or from people in organisations working with the disabled areencouraged to apply.

Women and candidates in provinces within the geographic focus of AusAlDis Country Strategy (see page 4) are alsoencouraged to apply.

ElisibilityIN GENERAL CANDIDATES MUST:

> be an Indonesian citizen and not have permanent residence !n Australia or New Zealand

> not be manied or engaged to a person who is eligible to hold Australian or New Zealand citizenship or Dermanentresident status, at any stage of the application, selection, mobilisation processes or while on-scholarship inAustralia

satisfy Australian Government requirements for intemational student entry to Australia (health, character etc)

not have obtained an academic qualification outside lheir home country in the 24 months preceding theapplication closing date, calculated from the date of arrival back in the home country

not be applying for another long-term AusAlD scholarship unless ihey have returned to their homecountry and resided there for twice lhe length of the total time that they were in Australia (for example, aprevious AusAlD scholar who has been on AusAlD scholarhip/s in Australla for five years will not beeligible to apply for another AusAlD scholarship until they havE been home for ten years)

be applying to commence a new course of study and not be seeking support through ADS for a course alreaqycommenced in Auslralia.

be able to take up the scholarship in the year for which it is offered

be able to satisry all requirements of the Department of lmmigration and Citizenship (DIAC) for an AusAlD studentvtsa and

tie able to satisfli the admission requirements of the Australian university at which the Scholarship is to beundertaken.

!I

B-&i;

SPECIFICALLY, CANDIDATES MUST:

> be applying for courses that fall within the areas of development pdority (see 'Choosing a Course of Stud/ belorrr)

> at the time of application, be not older than 42 years of age

have a Grade Point Average (GPA) of at least 2.9 on a scale of maimum 4.0 (ot 2.75 for appli&ns fromgeographic focus of AusAlD Country Strategy only, see page ii) and an English languags proliciency of at least5.0 in IELTS (or 500 In paper-based TOEFL or 61 in Internet based TOEFL). The IELTS or TOEFL result must becunent (a test result obtained in 2011 or 2012 will be considered cunent). No other English language test(including TOEFL prediction test) results will be acc€pted. Contact details of test centre must be provided forverification of TOEFL test results.

have a Grade Point Average (GPA) of at least 2.75 for awardees with a disability as declared on the ADSapplication form.

already hold an undergraduate degree, if applying for a Masters

already have a Masters, if applying for a Doctorate

apply for a dogree at a level higher than their cunent highest qualification

if applying for a Doctorate, applicants will be restricted to staff of universities, higher education institutions,

research institutes, key policy makers and largeted candidateb in other agencies associated wilh AusAlD activities

it is highly desirable for Doctorate applicants to have a letter of support from an Auslralian university for theirproposed field of study

answer all relevant questions on the application form -

be willing and available to undertake full-time (Monday - Friday 0800-1600) English for Academic Purposos

(EAP) training in Indonesia prior to studying in Australia, if offered a scholarship.

Choosing a Course ofStudyCandidates are encouraged to apply to study courses which fall within AusAlD's priority development areas (PDA).

The PDA relate directly to the strategic objectives contained in the Australia and lndonesia Country Strategy. An

indicative list ofthe areas for study follows

AustralialndonesiaPartne]shipPriodtyDevelopmentAreas {PDA}

Sustainabls Growth andEconomic Management

DemoclacyJustice andGood Governance

Invostlng In People Safety and Peace

Descriptlon ofPDA

lmprcving economic pollcyand management, red ucingconstmints to groMh ininfrastrucfure andproductivity, a n d improvingnafural resourcema n ag e m e nt, en v i ron me ntalgovemance and rcsponse toclimate change.

Strengthening thecapacity, accountabilityand responsiveness oflegal, democntic andoversight institutions, andimproving localgovemment and publicfinancial management.

Befter quality, accessand govemance ineducation, and befterheafth access andsysfgms

lmprgving rcsponsos tohumanitaian needs,emergencies andvulnembilv todisasfers, andimproving eapacity toensure transpodsecuity and to counterth(eats fromlransnational cime.

AustrallaIndonesiaPartnershipPriodty Fieldsof Study

. Natural Resourcel\ranagement

. Agriculture

. Aquaculture/fishories

. Forestry

. Climate Change

. Economics

. lnfrastructurePlanning

. Water and Sanitation

. RuralGrowth

. Smalland mediumenterprise development

. Law, legalandjudicial systems

. Political Science andGgvernment

. Public administEtion

. Public ependituremanagement

. Public SectorReform

. Environmental Law

. Anti-corruption

. Decentralisation

. Monitoring &Evaluation

. CommunicableDisease Prevention

. HealttlManagement

. Health Services

. Maternalahd ChildHealth

. Women andGender Studies

. Disability Services

. Public Health

. Educaiion andTraining

. EducalionManagement

. Human Resource .Developm€nt

. Childhood SpecialEducation

. Conflict Reolution

. DisasterPrevention andManag€ment

. Transport Safety

. TransnationalCrime Prevention

. DevelopmentStudies

. lnternationalStudies

i

i

I

I

1

NB: tf your study area is not listed here, you may still apply for a field of study related to the work of AUSAID in

lndonesia. For more information see the Australia Indonesia Par{nership Country Strategy at:

http://www.indo.ausaid.gov.auldocs/aipstrategyinfo'html

Candidates considering study for particular professions should note that ADS does not include the practical kdining

period required for professional registration, e.g. medical intemships, legal articles etc. succ€ssful awardees are

expected to complete such trainlng in their own muntry.

Selection ProcessAll applicants are considered by an independent Joint selection committee comprised of Australian and lndonesian

acajemics. Only those shorflisted will be interviewed. The inteMew will assess candidates' academic ability' clarity of

study goals, cultural adaptability. A critical consideration will be how well the ADS applicant is able to explain the

relevance of their proposed study area to the development of Indonesia. The interview will be accompanied by an

IELTS test of English language proficiency.

Final selection is obiective and based on the principles of mefit and equity. The final list of awardees is subject t'o

scruliny and endorsement by AusAlD and Government of Indonesia - State Secretariat'

SELECTION QUOTAS:

ln the 2o12l2}1g ADS cycte, up to four hundred and seventy five (475) ADS scholarships are available for

commencement in ZO13:2O14 including twenty five (25) Australian Leadership Award Scholarships (ALAS)' The

scholarships are allocated as follows:

> 213 of all awards will be offered inthe'Public Secto/ category

> 1/3 ofall awards will be offered in the 'Open' category

> up to 50 percent of awards will be offered in the Targeted Sector Category

> up to 30 percent of all scholarships will be awarded in line with geographic focus of the country Program strategy'

(The geographic focus will include East Nusa Tenggara, 'yesf 'Vusa

Tenggara' Papua' West Papua' and

Aceh)

> E5 percent of awards at Masters level and up to 15 percent at Docfrate (PhD) level. (NB doctoral level study

is on|y open to Staff of universities, higher education institutions, research institute, key po|icy makers and

targeted candidates in other organizations associated lvith AusAlD activities'

> an equal number of awards will be offered to men and women'

NOTIFTCATION OF THE SELECTION RESULT

All applicants will be advised wherher or not they have been selected for an interview' All interviewed applicants will

be noti{ied whether or not they have been awarded an ADS. The result is final and no conespondence will be entered

into.whereappropdate,notificationwit|inc|udedetai|sofpre-departuretraining(Eng|ish,academicski||s,cu|turalpreparation). This training is compulsory and tull-time (see page 7 for step by step of ADS Application Process)'

Requirements for Scholarship RecipientsPrior to travelling to Australia, scholarship recipients must:

>meettheminimumEnglish|anguagerequirementoftheirchosenAustra|ianuniversity(usua|ly|ELTSof6.5withno band less than 6.0)

>atthecompletionofEAPtraining,candidatesmustachieveaminimumscoreof|ELTS6.0forADSofficetocommence the application process for placemcnt in a university program in Australia

> receive a letter of acceptance lrom an Australian university

> meet Australian immigration requirements for a student visa

> receive Government of Indonesia endorsement

> be medically flt to commence studies in Australia

tllrRf,:7

In Austlalia, scholarhip recipients must:

abide by the conditions of the scholarship and the rules of Australian tertiary institutions

abide by the rules and regulations goveming a student visa

act in a way that will not bring disropute to AusAlD, or to any Australian university or to Indonesia

return to Indonesia for a period of two years at the completion of their study/research plogram in Australia. lfduring the two years exclusion period the scholarship recipients retum 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. Calculation oflhe two years exclusion period starts when the scholarships recipients arrivo Indonesia, not the visa expire date.

What do Australian Development Scholarships cover?> Pre-Course English - provision of English for Academic Purposes training prior io commencement of studies in

Australia (induding an in-lndonesia stipend)

> ln-lndonesia Stipend lor the period from the commoncement of Pre-Course English to the date of awardee

mobilisation. This does not apply to any deferral period.

Medical examination and x-ray cosfs in otder to comply with Studenl Visa requirements

AusAlD Student Visa and Student Dependant visa

Outward Airfare (economy- one way) from the airport closest to the awardee's home location to the international

airport closest to the Australian university selected for study by the awardee

Oyerseas Student Health Cover (OSHC) - awardee only (awardees are required to maintain OSHC for any

accompanying family in order to satisfy visa requirements).

Establishment Allowance payable into the awardee's bank accounl after'arrival in Australia

Contribution to Living Expenses (in Australia Stipend) - payment of a fortnigh{y contribution to living expenses

(cLE).

lntroductoty Academic program (tA,P) for a period of 4.6 weeks indertaken prior to the oommencement of

Masters or PhD studies

Masters OR PhD Tuition Fees - including all compulsory fees for the course in which the awardee is accepted

into

Supplementary Academic Suppott - provided where it is deemed essential to assist awardees to pass course

subjects.

Fieldwork - holders of a scholarship where research comprises at least 50 percent of the program may receive a

retum economy class airfare to Indonesia to undertake essential fieldwork.

Reunion Airtare - is available to a 'single' awardee 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 ADS, except

for the final year of the ADS.

Homeward Aiiare (economy- one way) from the intemational airport closest to the Australian university selected

for study by the awardee to the airport closest to the awardee's home location.'

FamilyEntryAwardees can bring their immediate lamilies to Australia at their own cost, if their families meet AusAlD and

immigration requirements. Families are normally permitted to join eight (8) weeks after the awardee's arrival.

Usefrrl websitesAustralia Awards: htF://australiaawards.gov.au/ -, '

Australia Awards - Development Scholarships: http://www.ausaid.gov.au/scholar

Australian Developmenl Scholarship (ADS) Indonesia: http://www.australiaawardsindo.or.id

Visas - Department of lmmigration and Citizenship: http://wwwimmi.gov.au

Studying In Au€tralla: http://www.studyinaustmlia.gov.au

Australian Educational Institutions and courses - the Gommonwealth Reglster of Institutions and Courses for

Overseas Sludents {CRICOS): http://cricos.deewr.gov.au

IELTS: http://www.ielts.org.au

TOEFL: http://www.ets.org/toefl

Ttre ADS Application Process

SteP 1

Applicantsends completeADS application form to

Australia Awards Ofiice by

17 August 2012.

Step 2Applicant is notified of -

the resull of selection for '

interview by December 2012.

Step 3

Applicant selected forinterview receives

information of interviedIELTS test date/location.

Step 4Applicant aftends

interview and IELTS test

in January 2013.

Step 5

Applicant is advised of

the result of their ADS

application by February 2013.

I 000053

Australian Development Scholarshipszorg Intake Application Form

Provide supporting documentary evidence of your full name, date of bi h, gender and muntry ofcitizenship. For example, the identification page of your passportor other offcial jdentification

documenl issued by your country oJ citizenship.

* Denotes mandatory field

Attach a recentpassport size pholo.

3x4cm.

n ur n utrs

[ fthe4Please specify)

Enleryouffumily name and other names as shown in yourBidr Cedificat€, Passpod or olher official idenlilicaliondorumenl. lf you have only one nam€, onlor il in bolh fields-

Gendef E Male E Female

Which country are you living in now?-

Have you applied, or are you intending to apply, for permanentresidency or citizenship in Aushalia or New Zealand?.

Passport no.

(provide if you have a

Residential address (Please dl€ck that your contact dehils arc corecl The sclrclaEhip applicatirn bkes several monlhs to be finalis€d. lt you

cannoi be conladed, )ou. applicalion will not ploceed.) .

Mailing address (Provide details only if bis is different b your qrrent resridenlial addrcss.)

Address line 1

Address line 2

Address line 3

Town/City

State/Province Postal code (if any)

Country

Phone and email (Provide at leastone contact number.)

Home phone no.' Work phone no.

lVobile no. Fax no. (ifany)

Email 1

Email 2

Currenl Work address (Please provide youf cunent work address where you can also be contacted. lf you cannot be contacled, yourapplication

willnol Droc€ed.)

Address line 1.

Address line 2

Address line 3

Town/City-

State/Province- Postal code {jf any)

Country.

:l!.

t;

lfyou have dependants (spouse and/or children under 18 years of age), provide theh details even if they will not

accompany you to Australia, Note that the scholarship does not provide financial supportfor accompanying dependants"

You can get information on your responsibilities for your spouse and any dependant children, should they live wittt you in

Australia during your scholarship, from the Department of lmmigration and Citizenship (DIAC) or by contacting the

university where you want to study.

Provide family name and other names as shovJn in your spouse's

bidh cedificalo, passport or other official identificalion doqJmenf

fssue date | |Passport no.

Prcvide if spouse

has a passpod * Expiry Date | |

Willyourspouse accompany you to Australia?r E yes n ns

Provide details ofany dependent children and indicate if they willjoin you in Australia.

A dependent child is the child or stepchild, of yourself or your spouse, who is not manied ot engaged to be married and

has not tumed 18 years of age.

NB: This Scholarship does not provide financial support for family members accompanying you to Auskalia.

lnformation on your responsibilities for any children that will live with you in Australia during your scholaBhip can bo

obtained from the Australian Government Department of lmmigration and Citizenship website or by contacting the

university where you want to study.

Child I Wll this child accompany you to Australia?* fl Yes E No

lssue date I I

Expiry date I I

Child2 Willthis child accompany you to Australia?* E Yes E No

lssue date I I

Expiry date | |

ChildS Willthis child accompany you to Australia?' E Yes E No

lssue date I I

Only include details of post-secondary school scholarships or fellowships.

Have you previously been awarded a scholarship or a fellowship?*

Provide details of a petson that can be contacted in case of an emergency. This may be a relative or a friend.

Title.tr lvtr I Mrs EMs n Miss ltr or

I other Please speciry

Family name-Relationship toyou*

Given name' Gendef E Male E Female

Home phone' Work phone

Mobile phone Fax (if any) .-

Email 1

tma I

Address line 1-

Address line 2

Address line 3

Postal code (if any)

Town/City'

State/Province'

Country*Please deck thatthe contact details are correct

Have you previously applied for an AusAlD scholarship but were

unsuccessful?*

lf Yes" how many times have you previously applied for ADS?

Have you previously been interviewed by ADS?*

lf 'Yes', in which years?

AusAlD strongly sncourages applications trom people with disabilily who arc otheryise eligible for a Sct'da|ship. Undet he AnbiwDisqinination Ad, Australian education inslildions have to provide ?easonable adJusfmenls'lo sludenls lvlfh disabiilfy lo assist access to sludy.

Io assess the ,keiy supp oi needs, appropiate assishnce, and tf,e capacity of relevanl insfitufions to prcWe the assistance, awadees with a

disabitity/special need nust provide detaits of lhe disability and/or special need when lhey accepl ket offer. ThiE intormalion is bound by

Australian pivacy laws and willbe disclosed only for the putpose of facilitating an accessible barier-free leaming envircnnent.

Modiflcalions lo physiaal or leaming eny]/rcnnenls, incluling addilional educatioral supporls such as sign interyrotets and captioning, nay be

avaitable depend@ on the relevant lnstilufion's capacity. AusAlD will adise the Instittfion of any special requienents associated wllh an

Awatdee so that the Inslttulion can pass these defa/h fo fhe ,nstilulion's Asability Liabon Otficer pior lo tf'e Awardee aniving on-canpus

Wherc an tnslilution is not able to ptovide the assislance requested, olher Inslilutions nay be rcconnomied.

Do you identify as having a disability or do you wo* in a dlsability-

focused organisalion?*'Under Australian law, disability includes physical, intellectual, pswhiatic, sensory,

neurological, leaming disabifies, physical disfigurenent, and the presence in llle body of

disease-caus,ing organisfi s

(hlt p : //www. hreoc. g ov. au /di sabi W -ights/ d d a 4 u i de /w h o /who. html)

lf yes, please provide details if you require special assistance or equipment to participate in the Scholarship selection

Drocesses or to live and undertake studies in Australia?

Iopenlf "Open", please indicate if your application is from:

n Private university

E Private individual

Epuotic

lf "Public", please indicate if your application is fTom:

n GovernmentDepartment

n State-ownedEnterprise

n State University

Have you obhined information from the ADS Information CD, or ftom the ADS

website regarding study options in Australia?

please describe the efforts you have undertaken so far to obhin information on your study options in Australia.

courses - CRICOS: http://cricos.deewr.gov.au

ADS - Australian Universities List

Following Australian universities are under contract to AusAlD to provide courses forADS awardees. Awardees are

,.quilaio nno . *itable course of study at one of these Australian universities. PhD candidates must find a supewisor at

one of these universities. please visit the following website for more details on Australian Educational Institulions and

. UiNercity ol Canbena

. UnivereJry of Newcasae

. lJniversity of Naw England

. Univsr'ity ol New sr'uh Wales

. Unlv6retyotsout Aust'aria

. Universily of Soulhem Queensland

. Univercily otfasnania

. llnivew of fschnolw SYdneY

. Universry otfie Sutsltne coast

. Universv of Westen SYdneY

. Unive(sily ot Wollongong

. Viclotia Universily

. Bffid Univercity

. The lJnivercily of Nolre Dane Ausl'EIa

. Mutdofi Unive$ity

. Queersiand Unive6/iy ot Technology

. RMlf Universiy

. SoullEm Crcss Univeat?

. Swinbune Univetsily of Tochnology

. Ihe Auslialian Naflonal Unive/|sily

. Ihe Flinders Uniwrsily of Souk Ausldia

. The Uniwrsw ol Adekide

. The Uniw6ily of Molboune

. the Univotsity of Q/4"enslad

. The Uniwrw of Syd(eY

. fhe lJnivetsity ofwesten Australk

. IJCL Sctool ot EneryY ard Resources

. UnivercW of Ba arat

Australidt itailine College

Australim Aholh UnivercW

Canagie llellon U n ivedryCentnl Queenslmd Llniverary

Chades OaMin U nivetsily

Ghades Slurl Unllers,lY

Culin Unive(silY of TechnologY

Deakin UnivetsitY

Edifll CMan Unive$itY

Gtifith UnivetsilY

Janes Cook Univo's'itY

La Trobe Unive$WMacquade Univercity

Monash UnivetsllY

lf you are selected for the scholarship the Australia Awards office will foruard your application to.your prefer Aushalian

uriiversity ano course of study You need to decide which.Australi* u!il9'.1y-19:y.1'li::i:19::**1tTlL",'".#ff;ffi il*;: ,ffi;';i iioo-r-. t*o .our,r., of study. you are enmuraqed to choose rwo difierent Australian

universities rather than tlvo different cou;es at the same university. lf your application for the first choice of study is

unsuccessful, AusAlD will forward your application to your second choice The CRICOS code from your course can be

found on the Commonweam negister ofinstitutions and Courses for Overseas Students (CRICOS) Website

http://cricos.deewr.gov.au

To find out about the content of specific murses, you should refer to the individual Austlalian university webslte-s This.

information can also be tound on the nD-S'ln6*itio. Co *rli.rt ,an be obtained from the Aushalia Awards otfice or ADS

Course title or Particular focus

area within your identified

proposed Field of StudY..

Minimum English

language proficiencY

required for the course

(IELTS) (if applicable)

Course duration (weeks)(ifapplicable)

Course tite or partiorlar focusarea wihin your identifiedproposed Field of Study."

CRICOS code 1it appticauel'

Coune duration (weeks)(if applicable)

Minimum Engllshlanguage proficiency

requhed for lhe course(IELTS)6*applicaute)

A formal offer of admission will not be required however it is expect€d seriousPhD candidates will have made preliminary enquiries to possible Australianuniversities regarding heir sfudy.

Have you discussed your proposed course with a member ot shff trom anyAustralian universiw This is highly recommended for Pho applicants. lf'Yes',please attach any relevant conespondence with Australian universities.

D Yes !ruo

Are there any special subjects or skills development that you would like to includein vour choice? I Ye. nuo

lf "Yes" please give details. (Note that ADS does not include the practical training peiod required for professional

regiskation, e.g. medical intemship, legal articles etc. Applicants are expected to complete such practical training in thehown counry).

I

Ii

Comp|etethissectionifthestudieswi||beby.Researchoracomo,n.ffi

;:lytrf,T"rJ,[:,j#;:t*9,::f,::l1p:T^1y,$91 ,^;#,io,iio"*no,,uursuncjenrtoexprainrhei::is;tJ::'"*""hproposartothesere.tionp'nir.nrei'.noi;ffi;;"id:liffiid"jJiiffiiilffil;iilIfu

Research title(max 250 chancters,approx 3L50 wrds linit)

What is the background tothe research beingproposed? (maximum 1i0wotds / + 1,000characters)

Provide a Research

Shtement (purpose ofsfudy) to accompany theproposed research. Thiscan include a statement onwhat is special and uniqueabout the research?)(maximum 100 wods / +700 chancters)

What hypothesis are youtesting in your proposed

rcseardfl (maximum S0words/ + 350 characters)

What are the objectives ofthe proposed research?(maximum 200 words / +1,300 chancters)

What is the

mehodology/stucture in

your proposed research?(indude commenls on

measure{nenb, data

sources, mehods ofanalysis and timelines)

(maimum 2N wotds / +

1 ,300 characters)

Have you published any

researd to date? (include

texts, joumal articles -providing full citation)

Which university do you

mnsider appropriate foryour proposed studies?

V'ftrf (naxinum 50 words /+ 350 characterc)

Have you considered apossible research

$upervisor? Why hisselectron?(naximun 50

wotds / + 350 charadets)

\ryhat is the relevance ofthe proposed research to

lndonesia?

Does your proposed research include fieldwork?'

lf'Yes' please provide a description of the fieldwork you will be undertaking. (Max 1000 charccters, approx 200 words

Iimit),

What is the duration of your proposed fieldwork? (if known)

In which country will you undertake lhe proposed fieldwork?

Proposed fieldwo* supervisor (if known)

List qualificatlons (whethor complete ot ||ot) by level of study, starting wlth the hlghest. lf you have not mmpleted

your studies please iist yow anticipated end date. Applicanb are required b fill out he total GPA obtained and tne 1

maximum GPA possible for each qualificalion noted below.

ihree certified copies of offcial transc{ipts and certificates MUST be induded with his application. lf you are selected for

interview, you MUST provide certified English lranslations when you attend the interview'

! Secondary (High School)

I Undergraduate (S1)

Vocational, Technical

(Dllln orDvU)

Postgraduate (S2l or S3n)

n Pending results I Incomplete

n

tr

Secondary fiigh School)

Undergraduate (Sl)

n

D

Vocational, Technical(Dllln orDvn)

Posgraduate (S2[ or S3[)

Startdate' I I

End date- | |

I Pending results I IncomPlete

n

n

Secondary (High School)

Undergmduate (S1)

fl Vocational, Technical(DlllE orDIVD)

n Postgraduate (SZ[ or $[)Level of study

Start date l I

! Pending results I IncomPlete

Applicant must have an English language proficiency of at least 5.0 in IELTS (or 500 in paper-based TOEFL or 61 inintemet-based TOEFL). The IELTS or TOEFL (lnstitutional or Intemational) result must be current (a test result obhirled ih2011 or 2012 will be considered cunent). An original copy of your IELTS oiTOEFL certificate must be attached to the'application form. NO other English language test (including TOEFL prediction) result will be accepted.

ls English your first language?

lf 'Yes' go to rcrt sedion. lf'No' answar he tollowing quegions:

Was English the language ofyour highest level of study? EYesDNolf 'Yes', ptovide a stalened fron tllP- univerclry veivng the lwuage of instruction.

Have you taken an IELTS or TOEFL test? E Yes D No

Tesl name (e.9.

IELTS or TOEFL)

lf 'No', when do you expect to complete thetest?

Please answer the following questions to the best of your ability. This will a$sist Australian universities to decide whether

Are you computer literate?* I Yes, n No

How regularly do you use a PC?* ! Weetly E Monfily

Do you have experience with the following software?*

EYesnNo fl Yes fl No

E Yes tr No fl Yes n No

EYesDNo Statistical packages {e.9.SPSS or Minitab)?

EYesnNo

List any formal computer courses you have undertaken.

FP'

C{nent employment may include work experience and voluntary work.Title'if you are not cunently employed. you must pmvide a cunent CV.

Please enter'Not Applicable' in the ,position ,

Level of position in

organisation structure(eg. Echelon and Golongan)

I GovernmenyPubtic E NGO /Civil Society flprivateBdefly de$cribe the work ofyour organisation and lheservlce it provides.

Briefly desffibe your cunentduties and responsibilities(max 5m chamcleE, approx80100 words limit)

Do you intend to return lo this organisation after your scholaFhip in Australia?* IYestrNoIf 'Yes', what role and

responsibilities do you

expect to undertake afleryour academic studies?(nax 500 characters, approx80-100 words limit)

What specific tasks do you

anticipate being able toundertake after youracademic studies? (specify

at least 3) (max 500ch aracters, approx 80 - 1 00words linit)

Only provide previous employment lhat is relevant to your application. Employment hislory should also include work

experience, community work and voluntary work.

Duliedresponsibilities(max 500 characters, approx

80-100 words limit)

Duties/responsibilities

(max 500 characters,

approx 100 words limit)

Please tick your prefened interview center. (Please note Your choice is not guaranteed.)

I Makassar

n Manado

I Kupang

I Medan

! Padang

E Balikpapan/Banjarmasin

! Jayapura

I Jakarta

I Yogyakarta

fl Surabaya

I Denpasar

tLimit your answeB t0 500 characters, approx 801 00 words, per question. Aftach a page if not enough room on this forry.Please note word limits, Anything overthis limit will not bs considered.

1. Why do you want to study in Australla?'

2. What skills and knowledge do you hope to gain and how dd you propose to use them?*

3. How have you contributed to solving a challenge and to implementing change or reform? (Be specific andinclude: what aspecus ofyour leadership knowledge, skills and practice you consider to be well established andeffective; which people or organisations you worked with to solve the problem; and what creative methods wereused.)?'

4, What specific development priority will you oonttlbute to on your return home and how do you intend to doso?*

fl Yes tr tto

5. Do you wish to be considered for a supplementary Leadership Award?

Refer to the Handbook for turther details on the supplementary Leadership Award.

6. Do you cunently have any connection or relationshlp to any staff employed at

AusAlD Posts or with AusAlD's managing contractors?'

7, Are you subject to any criminal or civil proceedings that are cunently awaiting

legal action?*to live and underhke studies in Australia?)

lf'yes'p/ease expand P/eas e nole information provided herc will nol necessaily disqualv you hon subnilting this schola6hip applicalion.

22

Professional memberships may include community, cultural, political, scientific, pmfessional and/or educationalassocialions and oroanisalions.

Highest position held (if any)

Highest position held (if any)

Highest position held (if any)

Where did you first leam of the Australian Development Scholarshlps?(tick box and specify where asked to do so)

n AusAlD scholarship recipient n Australia Awards website u AusAlD or Managing

Contracto/s Office

! Friend, relative or colleague tr AuSAID Website n Home institution or univefsity

tr

Australian Embassy orAuskalian Education Centre

(specii/ location) tr

Australian insiitution oruniversity

(specdy) uPublication, Radio, TV

(specify)

!Workplace or nominating authority

(specify) nOther

{specify)

From where did you obtain vour application torm? (tick box and specify where asked lo do so)

tr ADS website n ADS Office n AusAlD Office

n Friend, relative or colleague n DEEWR Office n Gol State Secretariat Office

trEducation Agent (speciry)

nHome institution or university

(speciry) nAusAlD project office

(speciry)

nWorkplace or nominating auftority

(specify) nOther

(specM

Please note: You are responsible for pmviding all supporting documents are provided, lf you do not provide all required

dooments your application will be reiected.

> THREE COPIES of the completed application fom. -r

F At least one mpy of the application form should have certified* copies aftached of the relevant documentslisted below.

) Where odginal documents are not in English, you must provide certified* copies of official English fanslationsif you are selected for an interview.

' Ceftified: a statement hat the document is a true @py, signed by a Commissioner of Oaths, Publlc Notary ot dherfomally rccognised auhority. lf Wu arc unsurc about who is the apprcpiate person to cew Wur documents, youshould contact the ADS Ofrice.

Required documentation: please tick ifyou have attached the following documents in suppon of your application.

All applicants: (Essential)You MUST include all S|e essential documents. lf at least one essential document is not provided, your application will be

automalicallv reiected.

copies of birth certificate or equivalent EYes I N/A

proof citizenship i.e. KTP or your passport personal information pages [Yes f] N/A

curent Cuniqllum Vitae flYes nN/A

offcial (certified* ) poslsecondary and tertiary certmcates/degrees flYes n N/A

official (certified. ) post-secondary and tertiary transcripts of results lYes E N/A

current (odginal) IELTS oTTOEFL English language test results (a tesl result obtained

in 2011 or2012will be considered cunent). TOEFL prediction test is NOT

acce0ted.nYes n N/A

Maslers applicants must also attach certified Dlll degree certificate/transcript if usingDIV or S1 extension certificate/transffiol nYes E nn

Doctorate applicants must also attach certifled S1 degree csrtificate/transcript nYes I N/A

academic reference from 52 supervisor for Doctorate candidates flYes D tlnDoctorale and those lvlasters applicants whose study will include at least fifty percent

research must fillthe research prooosaldetails on Daqe 15 of this application formnYes n N/A

Additional Documents: {Optional)Aoolicants must Drovide the followinq documents if thev are selected for an interview,

recent photograph (3 x 4) lves I NiA

official (certified* ) English translations of post-secondary and tertiary

certificates/deqreesEYes n N/A

official (certified- ) English translations of post-secondary and tertiary transcripts ofresults

flYes [] N/A

references from 51 suoervisor for Masters candidates (if available) nYes fl N/A

list of relevant publications, unpublished theses (for research applicants) lYes fl N/A

statement frcm university that English is a language of instruction (if applicable) nYes n N/A

relevant correspondence wilh an Australian university (if available). EYes D N/A

official (certified.) English translations of birth certiticate nYes n N/A

l{ARNll{G: rAind t^ im^^rtant .nnrtitinn( ,ftr.iad t "

r.In section 22, 23 and 24 you will be agreeing to important conditions attached to your award andyour study in Austtalia

Failure to comply with these condilions will mean that you may incur a debt to the Govemment of Australia and your

sdlolarship may be tenninated.

DO NOT sign the declaration at the end of section 23 and 24 untilyou fully understand the conditions of the scholarship

award. lf p-u have any problems understanding Section 22, 23 and 24 you are shongly advised t0 seek clarificalion of

these conditions from the Australia Awards 0ffice.

lf you are offered a scholarship you will be asked to agree to certain conditions before accopting the scholarship. The main

conditions are set out below for your information.

In accepling an Ausfalian Development Sdrolarship, you $'ill be asked to:

. take up the ADS in the academic year for which it is offered;

. complete a full study program during the course of lheir scholarshipi

. not hold another Australian Government scholarship at the same time as the ADS;

r participate in the Pre-Departure Briefing ananged by the Post, and the univeBity's compulsory Introductory

Academic Program (lAP) on arrival in Australia;

o reside in Auskalia for the duration ofthe ADS (apart ftom holidays, reunion visits of fieldwork visits to their home

country);

complete their ADS award within the period stipulated in hek Student Contract;

only undertake the approved program for which the ADS is offered and abide by tre rules of the university;

maintain an appropriate study load and achieve satisfactory academic progress in the program forwhich the

ADS was offered:

participate in all activites associated wittt the approved course of sfudy,.including all lectures and tutorials,

submii all work required for the course (e,g. assignments or essays) and sit for examinations;

not undertake any additional off-scholarship tertiary studies during their time in Australia on an AusAlD Student

Visa;

be aware that any employment undertaken during term tjmes may compromise academic progress;

liaise with the student contact officer at he university regarding any proposed changes to the approved .

progrrrn ano "rr,no*ledge

that approval is required from the university, AusAlD and Partner Government before

any changes are maoe;

agree to AusAlD mllecting information concerning the student or dependants and passing that information on t0

other relevant parties, if necessary;

advise AusAlD immediately, via the Student Contact Officer at the university, iflhey marry a person who is an

Australian or Newzealand citizen, orwho has permanent residence stalus in Australia or Newzealand. The

change in a student's marital status may affect eligibility to maintain the ADS Schohrship, and the Debt to the

Comironweatttr may apply if the student does not return to theh home country for a period of 2 years;

retum to thek country of citizenship for two years at the completion oftheir studyifesearch program in Austlalia;'

be aware that a Debt to the commonwealth of Australia will be incurred if a student fails to retum to their home

iiffi oiit tnev aonly for Permanent Residence or for a visa to remain in or return to Australia within the twg

year period; and

that any time spent in Australia during the two yeaf return home period will accordingly extend the end date of

the two year period;

agree that their ADS may be terminated at any time for failure to make.satisfactory academic progless, failure to

.irpl' *itf, ti . fu*r of Ausfralia, misconduct, breaches ol the contract between the Sfudent and the

Comnionweatttr ot Rustralia including breaches of the conditions of the ADS or of the AusAlD Student Visa or if

trey apply to change their visa status.

Subjecttoyourfulfi||ingtheseconditionsAusA|Dwi|Iprovidethefollowing,(eiherdirectlyorthroughtheAustra|ianSubject to your fulfilling these conditions AusAlD will provide the lollowng' (emer olreouv ur urruusrr urE ^vo{ons''

university):

.P]e.cou'seEnglish_provisionofEnglishforAcademicPurposestrainingpriortocommencementofstudissinAustralia (including an inJndonesia stipend)

.|n-lndonesiaStipendfortheperiodfromtteommencementofPte.CourseEng|ishtolhedateofawardeemobilisation. This does not apply to any deferral penod'

o Medical examination and x'ray costs in order to comply with Sludent Visa requicments

. AusAlD Student Visa and Student Dependant Visa

. Outwad Alrfare (economy- one way) ftom the airpofi closest to- the awardee's home localion to the

l.t i.ril..ri riipoh Uosesito tfre nustralian university selected for study by the awardee

.overseasStudentHea|thcover(osHc).awardeeon|y(awardeesarerequiredtomaintainoSHcforanyaccompanying family in order to satisfy visa requirements)'

. Establishment Allowance payable inlo the awardee's bank account after arrival in Australia

, contribution to Living Expenses (in Austnlia stipend) - payment of a forhightly contribution to living

exPenses (CLE)

.lntroductoryAcademicPrognm(|AP}foraperiodof4-6weeksundertakenpriorbthecommencement0IMasters or PhD studies

.lr|astersoRPhDTuitionFees-inc|udinga|lcompu|Soryfeesforthecourseinwhichlheawardeeisaccepleointo

.SupplementaryAcademicsupport-providedwhereitisdeemedessentia|toassistawardeeshpasscoursesubjects.

. Fieldwork - hOlders of a scholarship where research mmprises.at least 50 percenl of the program may receNe-

;ffi;;;;;"tv Jai, ai'tareio tnionesia to undertake essential fieldwork'

.ReunionAirfare-isavai|ab|etoa.singleawardeeafterthesuccessfulcomp|etionofthefirstyearofsfudy;subsequent reunion a,n r.

"ntii"l.iil iuil"t. .*ifufi. on

"n .nnual basis for the duration of the ADS' except

for the final Year ol the ADS'

oHomewardAirlare(economy-oneway){romtheinternationa|airportclosesttotheAustra|ianuniversityselecled fol study by ttrc awarOeeio tir'J airport closest to the awardee's home location'

Your universitY will Provide for:

. instruction and facilities necessary to complete the specified course

. appropriate academic and welfare support for the duration of your studies

. airport reception and temporary accommodation anangements on arrival in Austalia'

(NB: to be completed by fte staff memberwithin your organisation authorised l0 release staff for overseas study - for ,example stafi from the Intemational Relations Bureau (BKLN) / Centre for Educalion and Training / the Planning Bureau /

Rector from the university as appmpriaie. Applicants ftom outside Jakarta must have Sle appmval and nomination of their

relevant Kakanwil or Kadinas and approvalfrom Bupati or Govemor (or representative) where necessary.)

Please nole lhat your signahre on bis lorm signifies your agreement to the follou/ing:

. to release the applicant from work dulies while he/she attends English for academic training. This training is full'

lime and compulsory

o to release the applicant irom vyork duties after English for academic faining lo study in Australia, and process

their offcial passport and exit permit

. to mver the cost of travel to and from English for Academic Purposes training (Bali/Jakarta)

. to cover the cost of travel to he point of departure (Bali/Jakarta) prior to travel to Australia to cover llre cost of

medical examinations forfte applicanl A medical examination is an Australian lmmigralion requirement lo

receive a student visa

. to select a field ofstudy and level of study appropdate to the agency's needs

please also note that ll the application is for Doctorate level study, the signature by he authorised staff member confirms

that the applicant is a lectureilresearcher/key planner or policy maker and that Doctorate level studies are essential for

his/herfuture research and /or teaching responsibilities.

Applicanfs Level of position

in organisalion structure

(eg. Echelon and Golongan)

How long have you known the applicant and

in what capacity?

Please make any additional comments about

the applicant's potential or personal qualities

which you feel would be helpful to the ADS

Selection Team.

Ministrv/Aqencv Representative siqnature.o. b.hdf"f th. riri.t,y, I the undersigned, agree to be bound to the above commitments and strategies

Authorisation

AusAfD must mmply withlhe Pivacy Act 1988 in relation to the peisonal information pu have provided in this form.

By submitting this form I authorise AusAlD, or its appointed managing conhactor, lo access and/or obhin Information,

including copies ofany of my relevant academic remrddreports from the Australian University(s) that I have attend€d for

the following purposes:

. for use in the selection process for an Austfalia Award

. to monitor my academic performance at my host university while studying under an Australian Development

Sdlolarships

. to brief relevant Australian officials, Minislers and members of Parliament.

Should I receive an Australia Award, I consent to the Australian Government using and disclosing extracb of my

application (relating to my academic background and achievements, leadership skills and my proposed study program in

Australia) in promotional material in hardcopy and on fte Internet. I note that promotional material may include, bul is not

limited lo, media releases and information circulated to AusAlD's offshore Posts and Australian universities, conceming

the Auslralian Development Scholarships.

I authorise AusAtD to disclose the Dersonal information collected in this form to other Ausfalian Govemment depanments

lor lhe purpose of promoting and managing the Australian Development Scholarship.

Understanding

I understand and conirm that:

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

conect

, AusAlD has the right to vary or reverse any decision regarding an Australia Development Scholarships made on

the basis of inmrrect or incomplete information

. Decisions ofthe selection panel are linal and confidential and no correspondence about outcomes ofthe

selection process will be entered into.

Agreement

lf successful in gaining an Australia Development Scholarships, I agree thal I will:

. undergo a police or character check before my Aushalia Development Scholarships is confirmed

. immediately provide AusAlD with details of any incident that may reflect badly on the pres$ge of an Australia

Develooment Scholarshios

. act in a manner befltting a recipient ofan Australia Development Scholarships

. use the funds for the purposes granted

. acknov./ledge the assistance given by the Australian Government in any written reports, publications or publicity

associated with the Scholarships.

Declaration and acknowledgement

I declare, in submitting this application form, that the information contained in it and provided in connection with it is kue

and conect.

I acknowledge that giving fafse or misleading information is a serious otfence undet the Crtminal Code Act 19gs

of the commonwealth of Australia.

Endorsement by the Govemment of Indonesia .. '( To be completed by Head, Bureau ofTechnical Cooperation, Ministry of State Secretariat of tre Republic of Indonesia )

On behalf of the Government of Indonesia, I certify that I have examined the documents attadled to this form and am

satisfied that they are authentic and relate to the applicant.

I certifo that the maximum levelof study, field of study and lengffr of award pmposed in this application are appropriate

and in accordance with lhe Governments training policy.

I endorse the applicant for an Australian Development Scholarship

Notes: