APPLICATION FOR ADMISSION
as a Research Higher Degree Candidate
Please write in BLOCK letters using a black pen or TYPE.
Signatures can be inserted electronically (soft copy) or sign a hard copy (paper).
1
APPLICANT’S DETAILS
Title
Mr
Mrs
Family name
Given name(s)
Date of birth
(DD/MM/YYYY)
Ms
Miss
/ / Have you been enrolled at CQUniversity
previously?
Yes
Other
Gender
Male
Student number (if known)
No
Female
Address
Home address
Mailing address
Street Street/PO Box Town/City Postcode Country: Town/City Postcode Country: Phone number
(daytime)
Mobile
Phone number
(after hours)
Fax number
Email address
2a
CITIZENSHIP (DOMESTIC APPLICANTS
ONLY)
Please indicate your citizenship category:
If you are a permanent resident you must provide certified evidence of
your permanent residency status. Applicants with other citizenship
status should NOT complete section 2A. Please go to column 2b
opposite.
2b
CITIZENSHIP (INTERNATIONAL APPLICANTS
ONLY)
What is your country of citizenship as shown in your passport?
Australian citizen
Passport number:
Australian permanent resident
Do you hold a current Australian visa?
New Zealand citizen
Yes
No
What is your country of birth (if not Australia)?
If yes, what is the visa category:
Visa Code
Visa Type
What is your country of birth?
Application for Admission as a Research Higher Degree Candidate
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CQUniversity CRICOS Provider Codes: QLD - 00219C; NSW - 01315F; VIC - 01624D
Do you identify as an Aboriginal or Torres Strait Island person?
Yes, Aboriginal
Yes, both
Yes, Torres Strait Islander
No, neither
3
Do you identify as Indigenous in your country of birth?
Yes
No
AGENT DETAILS (INTERNATIONAL APPLICANTS ONLY)
Place stamp below (if applicable)
Is an agent representing you?
Yes
No
What country are you in when completing this form?
Counsellor’s name
Elsa-Marie Van Schalkwyk
Email address
info@rutegaeducation.com
Where should we send notification of your application results?
4
Mailing address
Home address
Agent
ENGLISH PROFICIENCY
Is English your first language?
Language spoken at home
Yes (Go to Section 5)
No
Do you hold a certificate of English proficiency (e.g., Academic IELTS or TOEFL)? If yes, please attach
certified results
Yes
No
Did you complete secondary, tertiary or English language studies in an English-speaking country?
Yes
No
Did you complete secondary or tertiary study with English as the language of instruction?
Yes
No
5
EQUITY ISSUES
Please cross the box/es as applicable. Please attach further information indicating any special assistance you may require if applicable. (This
information will only be used for statistical purposes unless otherwise indicated.)
Vision impairment/disability
Hearing impairment/disability
Learning impairment/disability
Medical impairment/disability
Mobility impairment/disability
Psychiatric impairment/disability
Other impairment/disability
Is additional information attached?
Special Assistance/Requirements
Application for Admission as a Research Higher Degree Candidate
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I would like to be contacted by the CQUniversity Equity & Diversity Office
6
PROGRAM DETAILS
Which higher degree are you applying for admission?
Doctor of Philosophy
Master of (specify)
Doctor of Education
Doctor of Professional Studies
What is your intended mode of attendance?
*Note: Before applying for on-campus/part-time or distance education, please check your visa requirements. All on-campus international
students must study full-time as per visa conditions. International students holding student visas cannot study externally whilst in Australia.
International website: http://www.cqu.edu.au/study/who-am-i/international-students/visas-and-part-time-work.
Full-time
Part-time*
Where is your proposed campus of study? (NB: You will be expected to enrol at a campus where your supervisor is located. You will
also be expected to reside in the city where your campus is situated.)
Adelaide
Gladstone
Rockhampton
Brisbane
Mackay
Sydney
Bundaberg
Melbourne
Distance Education
Emerald
Noosa
When do you propose to start your program of research?
/ / (DD/MM/YYYY)
Are you applying for a funded place or full fee-paying place?
Full fee-paying
7
Funded (i.e. RTS)
PREVIOUS RESEARCH CANDIDATURE
Do you wish to transfer your masters or doctoral research candidature from another
Australian or New Zealand institution?
Yes
No (Go to Section 8)
Have you enrolled in a research program at CQUniversity or another institution within
the last three (3) years?
Yes
No (Go to Section 8)
If you have answered yes to either of the above questions, please attach proof of your commencement date, enrolment history and EFTSU
consumption at that institution. (Note: Provision of this information is required by the Commonwealth Government.)
Name of Institution
Relevant course
Commencement date
8
RESEARCH
Have you discussed your research proposal and application with a CQUniversity academic?
Yes
No
If yes, please provide the name, phone number and email of the staff member(s):
Name:
Email
Phone No.:
What is the proposed title of research? (NB: Research proposal title must be entered in the box below for the proposal to be
considered.)
Application for Admission as a Research Higher Degree Candidate
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Research Proposal
Please attach your research proposal to this application. A minimum of one (1) page and up to a maximum of three (3) pages outlining the
proposed program must be attached to this application.
9
EDUCATIONAL BACKGROUND
Provide details of your tertiary qualifications.
(Note: You must attach certified copies of complete academic transcripts and official certification of awards and/or equivalency statements for
overseas qualification. If there is a postgraduate research component, please include the percentage of research undertaken. Do not include
secondary qualifications.)
Degree or Diploma
Level of
Honours (if
applicable)
Institution
Percentage of
Research
(if applicable)
Year
Completed
10
RESEARCH/PROFESSIONAL EXPERIENCE
Research and/or work experience relevant to this application. If claiming professional or research work experience, indicate exact
periods and duties performed.
Has your research been published?
Yes
No
If yes, please include full citation details in an attached document.
Curriculum Vitae
Please attach your curriculum vitae (resumé) to this application.
11
STUDY STATEMENT (INTERNATIONAL APPLICANTS ONLY)
To enable the University to undertake a preliminary assessment as to whether you are a Genuine Temporary Entrant (GTE) and a Genuine
Student, you are required to complete the Study Statement below by responding to all of the questions. Please note the Department of
Immigration and Citizenship (DIAC) will undertake their own determination of the genuinity criterion.
Please note: You must answer all the questions below as thoroughly as you can. (Please attach an additional page if you require
more space.)
1.
Why do you want to study in Australia?
2.
How do you intend to fund your studies for the entire duration of your stay in Australia?
3.
How do you believe your chosen program will contribute towards your current or chosen career path?
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4.
Do you have any previous immigration history such as visa applications, refusals and visa grants? Please explain.
5.
What are your current personal circumstances in your home country and within Australia, i.e., family/relationships?
6.
Why did you choose CQUniversity?
12
INTELLECTUAL PROPERTY (IP)
Prior to a candidate starting a research degree, where intellectual property (or the potential to generate intellectual property) is identified, the
ownership of that IP needs to be resolved (http://policy.cqu.edu.au/Policy/policy_file.do?policyid=1746 and
http://policy.cqu.edu.au/Policy/policy_file.do?policyid=1747).
Is it anticipated that there will be any intellectual property generated by or from this project?
Yes
No
Unsure
Note: If you do not understand this question, or are unable to provide an answer, this section can be completed on your arrival at CQUniversity
Australia and after discussions with your supervisor/s.
13
REFEREES
Give details of two professional or academic referees who are familiar with your work and state your relationship or association with these
referees.
a. FIRST REFEREE
Title
Mr
Mrs
Family name
Given name(s)
Home address
Town/City
Country
Phone number
(daytime)
Ms
Miss
Other
Postcode/Zip
Mobile
Application for Admission as a Research Higher Degree Candidate
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Phone number
(after hours)
Email address
Relationship/Association
Fax number
b. SECOND REFEREE
Title
Mr
Mrs
Family name
Given name(s)
Home address
Town/City
Country
Ms
Miss
Other
Postcode/Zip
Phone number
(daytime)
Mobile
Phone number
(after hours)
Fax number
Email address
Relationship/Association
14
AVAILABILITY OF RESOURCES
Does the proposed program of research require access to facilities other than those available through CQUniversity? You must
consult with your proposed supervisor(s) before completing this section.
Yes
No (Go to Section 15)
Nominate the venue at which you will have access to these resources.
Please provide details of those resources and facilities that will be available to support the proposed program of study and research..
Certification by authorised officer at proposed alternative venue.
I have discussed the proposed study and research program with the applicant and agree to the use of facilities and resources as detailed.
Title
Family name
Mr
Mrs
Ms
Miss
Other
Application for Admission as a Research Higher Degree Candidate
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Given name(s)
Organisation and address
Address
Town/City
Country
Position
Print Name
Postcode/Zip
(Surname, Title, First Initial)
Signature
Date
(Authorised Officer)
15
(DD/MM/YYYY)
PRIVACY STATEMENT
CQUniversity Australia is subject to the provisions of the Commonwealth Privacy Act 1988 and you are entitled to protection of your privacy.
This means that any information the University collects about you, including personal details, academic progress details, and personal welfare
information, is treated by the University according to strict guidelines. Access to your information is restricted to those staff that may need the
information in order to carry out their responsibilities in your personal and/or academic interests.
Other than in accordance with any legal or academic obligation, the University will not disclose personal information about you. This means we
do not release any information we hold about you such as your address, or your results, even to close relatives, without your permission.
The exceptions to the general application of these guidelines are the obligations imposed on us by law, Government regulation, or the
requirement for normal operation of the University. They include the following:
16
•
•
•
•
•
•
•
We advise Centrelink of your enrolment details if you are receiving payments;
•
If you are alleged to have committed a criminal offence, we may be requested to assist the police with personal information about your
for general enforcement.
We release statistical information to the Department of Education, Employment and Workplace Relations (DEEWR);
We release statistical information to the Department of Industry, Innovation Science, Research and Tertiary Education (DIISRTE);
We release statistical information to the Australian Bureau of Statistics (ABS);
We may publish your examination results and the award of a prize or scholarship;
When your award is conferred, your name will be published in the record of proceedings for the conferring of awards;
We give the Department of Immigration and Citizenship (DIAC), the Australian Agency for International Development (AUSAID),
DEEWR and DIISRTE certain information which we are required to release;
DECLARATION
I declare the information supplied by me on this form is true and correct in every particular. I authorise CQUniversity to obtain information from
educational institutions and relevant authorities concerning my enrolment, academic record, examination results and/or bond status.
I am aware that information relating to my application to undertake study with CQUniversity may be provided to the Department of Immigration
and Citizenship (DIAC). I declare that I am aware of and understand my financial obligations relating to study with CQUniversity. I have
genuine access to the total funds required whilst in Australia to cover all travel, OSHC, tuition and living costs for myself and any dependents
declared on this form. I understand that the University may elect not to proceed with my offer or Confirmation of Enrolment based on their
assessment.
Print Name
(Surname, Title, First Initial)
Signature
Date
(Applicant)
17
(DD/MM/YYYY)
I LEARNT ABOUT CQUniversity THROUGH
Website (please specify)
Australian Education Centre/Australian Education International
Application for Admission as a Research Higher Degree Candidate
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Private Agent
Advertisement (e.g. magazine, newspaper, etc.)
Educational exhibition/seminar
Australian diplomatic Mission
Personal contact/email (please specify)
Other (please specify)
Education Institution (e.g. GAC, Polytechnic, University, etc.)
18.
IMPORTANT INFORMATION (INTERNATIONAL APPLICANTS ONLY)
As part of the Student Visa program all applicants are required to undergo screening to determine if they satisfy the Genuine Temporary Entrant
(GTE) criteria, as defined by the Department of Immigration and Citizenship (DIAC), prior to the assessment of university entry requirements.
All applicants can expect to be contacted by a CQUniversity representative and asked a series of questions in relation to this criteria. Further
information on the GTE criteria can be located on the DIAC website http://www.imi.gov.au.
19
CHECKLIST
Have you attached?
Documentary evidence of English proficiency, if applicable
Certified documentary evidence of your citizenship or residency
Certified copies of academic records/qualifications, including all tertiary education transcripts (plus English translations, if applicable)
Evidence of your funding sources/arrangements (international applicants)
Curriculum vitae (resumé) with publication details
Research proposal
20
SUBMIT YOUR APPLICATION
Return to:
Research Higher Degrees Officer
School of Graduate Research - (CQIRP)
Bldg 361, Ibis Avenue
CQUniversity
Rockhampton Queensland 4701
Australia
Phone:
Fax:
Email:
07 4923 2607
07 4923 2600
sgr@cqu.edu.au
Application for Admission as a Research Higher Degree Candidate
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CQUniversity USE ONLY
21
STATEMENT BY PRINCIPAL SUPERVISOR
Title
Prof
Assoc Prof
Family name
Given name(s)
Dr
Mr
Mrs
Ms
Other
Indicate the number of higher degree students you are currently responsible for as a Principal Supervisor.
Masters/full-time
Masters/part-time
Doctoral/full-time
Doctoral/part-time
Will the applicant require ethical consideration and intellectual property rights?
Ethical
considerations
Yes
No
Intellectual
property
Yes
If no, please detail points of dissent in an
attached statement.
No
The appropriate accommodation, facilities and resources are available for the support of the proposed
program of research
Yes
Specify
The offer made to the applicant will indicate the proposed campus of study is
You must insert the codes appropriate to this application.
(Refer to http://www.abs.gov.au/ausstats/abs@.nsf/0/4AE1B46AE2048A28CA25741800044242?opendocument)
ANZSRC
FoR
Research Institute/Centre Affiliation
SOE
Certification – I am willing to supervise the candidate for the degree of
at (name campus)
Type of Research
Signature
Date
(Principal Supervisor)
(DD/MM/YYYY)
Supervision approval by line manager or equivalent:
Print Name
(Surname, Title, First Initial)
Signature
Date
Application for Admission as a Research Higher Degree Candidate
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No
(Dean of School or Institute/Flagship Director)
22
(DD/MM/YYYY)
STATEMENT BY ASSOCIATE SUPERVISOR
Title
Prof
Assoc Prof
Family name
Given name(s)
Dr
Mr
Mrs
Ms
Other
Indicate the number of higher degree students you are currently responsible for as an Associate Supervisor.
Masters/full-time
Masters/part-time
Research Institute/Centre
Affiliation
Doctoral/full-time
Certification – I am willing to supervise the candidate for the degree of
at (name campus)
Doctoral/part-time
Signature
Date
(Associate Supervisor)
(DD/MM/YYYY)
Supervision approval by line manager or equivalent:
Print Name
(Surname, Title, First Initial)
Signature
Date
(Dean of School or Institute/Flagship Director)
(DD/MM/YYYY)
Note: If additional associate supervisors are required, please include details on an attached memo with verification of their willingness.
23
ENDORSEMENT BY GRADUATE RESEARCH COORDINATOR
Do you recommend this applicant for admission as a higher degree candidate:
Yes
No
The applicant is recommend for admission into:
Masters program
Doctoral program
Yes
No
Yes
No
The relevant Line Manager (i.e., Dean of School or Institute/Flagship Director) has
certified that supervision can be undertaken by those nominated above
The relevant Line Manager has certified that appropriate accommodation, facilities
and resources are available for the support of the proposed program of research (see
section 21 for details)
Under which of the following categories has the applicant qualified for admission?
Masters degree no less than 50% research
Bachelors degree: Level Honours degree: Level Other (specify)
Relevant work/research experience
Masters by research
Specify any special conditions of candidature (e.g., coursework requirements).
Application for Admission as a Research Higher Degree Candidate
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24
APPROVAL FOR ADMISSION
I authorise admission to the candidate as detailed in the Description of Candidature approved by the Research Higher Degrees
Committee or its executive.
Print Name
(Surname, Title, First Initial)
Signature
Date
(Dean, School of Graduate Research)
(DD/MM/YYYY)
Application for Admission as a Research Higher Degree Candidate
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