2017 NEW COLOMBO PLAN
SCHOLARSHIP PROGRAM
APPLICATION FORM
This is the internal University of Sydney application form for the 2017 New Colombo Plan Scholarship Program. If you are
successful in the internal application process, you will be nominated to the Australian Government to be externally assessed.
APPLICANT INFORMATION
Last name
Given name(s)
Student ID
Date of birth
Home phone
Mobile
E-mail
Are you an Australian citizen?
YES
NO
Do you hold dual citizenship?
YES
NO
If yes, please advise which country you are also a
citizen.
EDUCATION
Degree enrolled
(Must be an
undergraduate)
When did you
commence your
current course?
How many credit
points have you
completed?
What is your
major
What is your
Average Mark
(must be over
80% by end of
semester 1, 2016)
Have you won any
University awards?
If so please list
them
STUDY COMPONENT
What is your proposed host University and country?
What is your intended study duration?
One semester
Do you intend to undertake in-country language training?
Two semesters
Yes
No
Have you travelled before to your proposed country?
Have you studied overseas before? If so, please state where
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SELECTION CRITERIA
The following are the selection criteria against which you will be assessed, including their relative weighting. You
should address each criterion. You should use the guidance to draft your response.
Criterion 1: Demonstrated academic excellence at the tertiary level
(40 per cent weighting)
Assessment of this criterion will relate to a) the applicant’s graded average achieved in tertiary
studies, and b) to ungraded academic achievements, such as academic awards and
commendations, publications, or other examples of academic excellence at the tertiary level. The
applicant’s communication skills, higher-order cognitive and critical thinking skills, and engagement
in learning will also be assessed. High School academic achievements will not be considered.
Criterion 2: Leadership in the community
(30 per cent weighting)
Assessment of this criterion will relate to the applicant’s demonstrated leadership in the community,
including volunteer and not-for-profit roles and/or activities they have undertaken in their local
community, nationally, overseas and/or in their university.
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Criterion 3: Adaptability and Resilience (15 per cent weighting)
Assessment of this criterion will relate to the applicant’s potential to adapt to change, thrive in a
different environment, and demonstrate resilience in the face of challenges.
Criterion 4: Ability to contribute to New Colombo Plan goals (15 per cent weighting)
Assessment of this criterion will relate to the applicant’s understanding of New Colombo Plan
objectives, and how the applicant and their proposed Scholarship Program would contribute to New
Colombo Plan goals.
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INTERSHIP/MENTORSHIP COMPONENT
Part of the conditions of the scholarship may require you to undertake an internship/mentorship. If you are asked
to do so, we would like to know your proposed plans (etc. what companies you intend to approach; what field you
would like to undertake this; what would be the aims, how long will you intend to do it for.) Please give the details
below.
REFEREE DETAILS
Please provide the details of two referees, one of which must be an academic referee. Both referees must
complete the referee report template supplied in your application pack. These reports must be returned as part of
your completed application
Referee One
Title
Institution/organisation
Last name
Position held
Given name(s)
Relationship to applicant
Phone
(include country
and area codes)
Lengths of relationship
Email address:
Referee Two
Title
Institution/organisation
Last name
Position held
Given name(s)
Relationship to applicant
Phone
(include country
and area codes)
Lengths of relationship
Email address:
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EQUITY AND DIVERSITY (OPTIONAL)
Are you an Australian Aboriginal or Torres Strait Islander? That is :



You are an Australian Aboriginal or Torres Strait Islander Descent and
You identify as an Australian Aboriginal or Torres Strait Islander and
You are accepted as such by the community in which you live or have lived
Yes
No
Choose not to give
Are you from a non-English speaking background?
Yes
No
Choose not to give
If yes, please nominate your first language
Do you have a Disability?
Yes
No
Choose not to give
If yes, please advise of the nature of your disability
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
Signature
Date
FOR OFFICE USE ONLY
WAM
Credit left at start of exchange
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