Higher Degree Research
Domestic Students
Scholarship Application Form
Please refer to the Domestic Students Scholarship Application Guidelines when
completing this form.
1.
Application Type
Australian Postgraduate Award (APA)
Other:
(Please provide the full name of the scholarship you are applying for)
2.
Personal Details
Title:
i.e. Dr, Mr, Mrs,
Ms, Miss
Family name:
Date of Birth:
Given name(s):
Gender
Day / Month / Year
Male:
Female:
(please tick appropriate box)
Please write your UNE Student ID Number (if known)
Current Mailing Address:
Full Address:
Country:
Post Code:
Email:
Telephone:
Mobile:
Special Needs
Do you have any special needs or considerations that we should know about?
Yes:
No:
(Please attach further information indicating any special assistance you may require, if applicable)
Aboriginal or Torres Strait Descent
Are you of Australian Aboriginal or Torres Strait Islander descent?
Aboriginal
Torres Strait Islander
Both
Neither
3.
Citizenship
Please indicate your Citizenship category (tick one)
Australian citizen, including Australian citizens with dual citizenship (you must provide verified
documentary evidence with your application such as birth certificate or citizenship certificate)
New Zealand citizen or a diplomat or consular representative of New Zealand, a member of staff of
such a representative, excluding those with Australian citizenship (includes any such persons with
Australian Permanent Residence status). (You must provide a copy of your passport/visa)
Australian Permanent Residence status but excluding New Zealand citizens. Enter the date you
became a permanent resident. (If you tick this box you must provide a copy of your passport/visa or
other evidence of permanent residency)
day / month / year
If you are an Australian Permanent Resident and born outside Australia, enter the year you arrived in Australia
day
4.
/ month / year
Candidature Details
Candidature Offer at UNE
Have you already been offered a place or commenced study in a Higher Degree Research (HDR) program at
UNE?
Yes
No
*
*If NO, have you made an application for HDR Candidature at UNE?
Yes
No
*
*NB: To be eligible all scholarship applicants must have applied for HDR Candidature at UNE.
Higher Degree Research (HDR) Candidature Application details:
HDR Course Name (eg. Doctor of
Philosophy):
School (eg. School of Science and
Technology)
Principal Supervisor:
Co-Supervisor(s):
Proposed Start Date
day
/ month / year
Proposed Mode of Study (Please Tick)
Part-Time
On Campus
Full-Time
Off Campus
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UNE – HDR Domestic Scholarship Application Form 2016
Off Campus Study
If you plan to undertake research work off campus, please specify where you plan to carry out your research
(e.g. CSIRO, DPI).
Research Proposal
Please outline the general area of research you wish to study and provide a brief description (minimum 100
words, maximum 150 words).
Title:
Description:
Current Study
Are you currently studying at an institution other than UNE?
Yes
No
If you are currently studying at an institution other than UNE, please provide details as requested below.
Name of Course of Study
Institution
Anticipated
completion date
Transfer
Are you applying to transfer your candidature and scholarship from another institution?
Yes
No
If you are applying to transfer your scholarship with masters or doctoral research candidature from another
institution, please provide details as requested below.
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UNE – HDR Domestic Scholarship Application Form 2016
Current Scholarship & HDR Candidature Details
Date commenced:
Scholarship:
Course of Study:
Institution:
(Please provide certified proof of your scholarship commencement date, as well as intermissions or changes
of HDR Scholarship and Candidature status that may have occurred during your candidature).
Confirmation of Candidature
Have you completed a confirmation of candidature?
Yes:
No:
(If yes please provide details)
5. Other Finance for Study and Other Income
Previous and Current Australian Government Postgraduate Scholarships (or any other Postgraduate
Scholarships)
List all PREVIOUS and CURRENT Postgraduate Scholarships that you have held:
Duration
Name of Award
Start Date
Institution
Value of
scholarship
End Date
Current Applications for Scholarships or for Sponsorship
Are you applying for, or have you arranged any other externally funded Scholarships or Sponsorship?
Yes
No
If ‘yes’, and you have already received a Scholarship or arranged Sponsorship, please provide the following
details:
Tuition Fees
Living Expenses
Value of Living Expenses:
(per year in AUD)
$
Please provide the name of the Scholarship or Sponsor (i.e. Government sponsor):
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UNE – HDR Domestic Scholarship Application Form 2016
Are any other benefits included? (please specify):
Other Income
Would you be receiving any other income whilst you are receiving the Scholarship you are applying for?
Yes:
No:
(If yes please provide details)
6. Academic Qualifications and Awards
Previous Qualifications
List below all tertiary level studies.
Degree or Qualification
Institution and
country
Date completed /
Expected date of
completion
Proportion of Language of
Research
instruction
Awards Achieved During Previous Study
Have you received any academic awards during previous study, i.e. University Medal?
Yes:
No:
Please list the Awards you have received with information about the award (if insufficient space, please
attach further information).
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UNE – HDR Domestic Scholarship Application Form 2016
7. Research and Relevant Experience
Postgraduate Research Experience (Past Five Years Only)
Please describe briefly any postgraduate research experience you have had over the last 5 years (if insufficient
space, please attach further information – 1 page maximum).
Employment History (Past 5 Years Only)
Please detail any relevant work experience. (if insufficient space, please attach further information – 1 page
maximum).
Name of employer
Your duties/position
Dates
Publications
Please list your top 6 publications (if insufficient space, please attach further information). DO NOT provide
copies of publications.
For example: Smith. J., Brown. S., Shaw. P. “Title”, Name of Publication, Type of Publication, (e.g., referred journal
article, non-referred journal article, book chapter, review etc.), Publication Details (e.g., Volume 29, issue 2, 2005).
(If insufficient space, please attach further information – 1 page maximum)
Author(s)
Title of Publication
Type of Publication
Publication Details
Non Traditional Research Outputs
Please list your top 6 non-traditional research outputs such as original creative works, live performance of
creative works, recorded/rendered creative works and substantial public exhibitions and events.
Creative work
Documentation
Original artwork
Original music (includes notated and/or
improvised music for any medium
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UNE – HDR Domestic Scholarship Application Form 2016
Original theatre performance /
production, original script for performance
Original performed choreography /
production
Screening of original film work including
documentaries
Publication of a piece of creative writing
Environmental design (for architect,
landscape architect, urban designer)
Performance of music, theatre, dance, film
8. Academic Referee Reports
All applicants must organise two Academic Referee Reports.
Applicants must also provide contact details of their referees on this application form and ask the referees to
submit their written reports directly to the University on the Referee’s Report Form which can be downloaded
from the UNE website available at:
http://www.une.edu.au/__data/assets/word_doc/0016/52126/Referees-Report.docx
Referee 1
Referee 2
Name
Position
Institution
Postal address
Telephone/mob
Facsimile
E-mail
9. Statement of Support from Supervisor
All applicants must organise a Statement of Support from their proposed Principal Supervisor. This
statement should be no more than 500 words. The Statement of Support should outline alignment of the
applicant’s research proposal with the School research priorities and provide a clear indication of the level of
support of the student’s project.
If it is applicable this Statement of Support should clearly state if the student’s study will be part of an external
grant and/or other external project or partnership.
It is the applicant’s responsibility to ensure that this Statement is submitted to the University by the closing
date of the scholarship round so it can be considered with the scholarship application. There is no specific
form and the Statement of Support can either be submitted direct to Research Services by the Supervisor
via email to hdrdocuments@une.edu.au or it may be supplied by the Supervisor to the student for
attachment to this application.
Please note the University will not request this statement on your behalf.
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UNE – HDR Domestic Scholarship Application Form 2016
10. Declaration
Giving false or misleading information is a serious offence under the criminal code (Australian Commonwealth)

I declare that I have read and understood the questions on this form and that the information I have
supplied on this form is correct and complete.

I understand that the University may vary or cancel any decision made on the basis of incorrect or
incomplete information provided by my referees or me. If any information is discovered to be untrue or
misleading in any respect I consent to the University collecting, storing and disclosing this information to
Universities Australia and University Australia member institutions, the Australasian Conference of
Tertiary Admissions Centres (ACTAC), and any other relevant authority.
I authorise the University to obtain official records from any institution I have attended.
I agree to abide by the University of New England’s Conditions of Award and Conditions of Scholarship
which may be amended from time to time by the University.
I understand that giving false or misleading information is a serious offence under the Criminal Code
(Australian Commonwealth).



Please sign and date this application below before printing, scanning and returning to us electronically or
mailing to us.
Your application will not be processed if it has not been signed below.
Signed
Date
/
/
Applications may be submitted online, by mail or by fax
Online:
Mail:
Via the AskUNE website
Research Services Directorate
TC Lamble Administration Building
http://yourfutureaskune.custhelp.com/app/utils/login_form/redirect/ask University of New England
Armidale NSW 2351 Australia
Fax:
+ 61 2 6773 3543
Scholarship enquiries should be directed to Research Services (contact details below)
Research Services
Phone: + 61 2 6773 3715
Fax:
+ 61 2 6773 3543
https://hdr.custhelp.com/
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UNE – HDR Domestic Scholarship Application Form 2016