APPLICATION FORM

THIS APPLICATION FORM IS FOR INTERNATIONAL STUDENTS ONLY

This application will not be processed unless all information has been provided. PLEASE PRINT CLEARLY. CLOSING DATE FOR SCHOLARSHIP APPLICATIONS: 31 AUGUST APPLICATIONS FOR CANDIDATuRE MAY BE SUBMITTED AT ANY TIME. (Except for PhD Clinical Psychology and PhD Health Psychology Applications. 1 October for admission only) Agent/Representatives Stamp and Address

research higher Degree

SECTION ONE PERSONAL DATA

1. Personal details Title (Dr, Mr, Miss) Family/Last Name First Name Other Name/s Previous Family Name Date of Birth D D M M Y Y Y Y Female Male

2. Contact details (Home Address) Number and Street

Suburb/Town/City State Country Postal/Zip Phone Phone Email Address 3. Previous student Have you previously been a University of Newcastle student or applicant? Yes No Student ID Number

Country code

Area code

Mobile/Cell/Handphone Number

Country code

Area code

Home Number

4. Country of birth Please Specify 5. Country of citizenship *NB Evidence of citizenship MUST be provided. Please Specify 6. Disabilities The information provided below will assist the University in monitoring and improving services to assist students with special needs. Do you have a disability or long-term medical condition which may affect your studies? If Yes, please indicate the type of disability that applies: Do you require Support Services? Yes No Hearing Vision Yes Learning No Medical Mobility Other

If Yes, please indicate the type of support services you require:

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SECTION TWO PROGRAM(S) TO WHICH YOU WISH TO APPLY

7. University program for which admission is sought (eg. Master of Philososphy, Architecture) Program Master of Philosophy (MPhil) Doctor of Philosophy (PhD)

Degree Name

Program code

Campus Start Date:

Callaghan Ourimbah Y Y Y

D D M M Y

Research candidates may commence their candidature on almost any weekday during the year and are asked to nominate their intended start date. Candidates who commence their study between January and June are enrolled for Semester 1; candidates who commence between July and December are enrolled for Semester 2. Fees are charged on a pro-rata basis, from the commencement date, for the rst semester. For subsequent semesters the full semester fees apply.

8. Research Topic

9. Research Proposal (Description of proposed research at this University. Please attach a typed statement) Who have you discussed your proposed research project with at the University of Newcastle? Name Name

A statement indicating the nature of research you wish to undertake MUST be provided. A Research Proposal template is available for your use on page 65 of this prospectus and at www.newcastle.edu.au/students/research-higher-degree/future-students/forms

Section three RelateD eXperience

8. Education Provide specic details of all Undergraduate/Postgraduate studies undertaken. Please attach additional pages if necessary. *NB Evidence MUST be provided for all qualications claimed. Career Qualication (B.Sc, M.A. etc.) Institute (eg Nanjing University) Country (eg China) Study Commenced (eg Mar 2008) Completion date/ Expected date of Completion (eg Dec 2012)

Undergraduate Graduate Master (Coursework) Master (Coursework with research component) Master (Research Higher Degree) PhD/Doctorate (Research Higher Degree)

Section FOUR ENGLISH

9. Language Indicate your current English language prociency. Is English your rst language? Yes No If No, what is your rst language?

Have you completed any of the following Language Tests in the last two years? IELTS iTOEF Other Date of Test D D M M Y Date of Test D D M M Y Date of Test D D M M Y Y Y Y Y Y Y Y Y Y TRF# REGIST#

If you do not meet the English prociency requirement, you may be required to undertake ELICOS at the University of Newcastle. Evidence of English prociency must be provided by 31 August each year to be eligible for consideration for scholarship. The English prociency policy can be found at www.newcastle.edu.au/policy/000104

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Section FIVE SCHOLARSHIP INFORMATION

* Applications for scholarship may be submitted between 1 January and 31 August each year. Applications submitted outside of these dates will be considered for admission to a Research Higher Degree only. A complete Scholarship Only application may be submitted in the following year. * NB Evidence of meeting English proficiency MUST be provided by 31 August to be considered for scholarship. NOTE: Applicants who have not completed ELICOS by December each year will be ineligible for a main round scholarship. 10. Research Scholarship details Are you applying for a University of Newcastle research scholarship? Will you be receiving a scholarship from your home country or government or another source to support your research higher degree studies? If Yes, please attach evidence of the scholarship you are applying for or have received and complete the following: Sponsor Amount per annum Yes Duration No Yes Yes No No

Have you ever received an AusAID or postgraduate scholarship before? If Yes, please complete the following: Scholarship Institution Value End Date D D M M Y Y Y Y

11. Relevant experience and employment Please detail below or attach a Curriculum Vitae detailing relevant experience and employment. Include in your c.v. any research or development work undertaken to date e.g. work as a research assistant, publications or other research attainments. Evidence of any claimed publications/exhibitions/research attainments must be provided. Attach the front page of publication or advertisement for exhibition and a letter from your employer for research work experience on company letterhead. Where evidence is not provided, publications/exhibitions cannot be considered in the assessment of your application.

12. Referees Please list 2 referees (name, title, institution, email address and telephone number) Name Institution Email Phone Name Institution Email Phone

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Section SIX Checklist

Important checklist to ensure a quick response to your application. Complete all sections of this application. Ensure you attach certied copies of all previous qualications including award certicates (if applicable), and academic transcripts with grading systems descriptions. Qualications and transcripts must be certied by a University of Newcastle representative or agent, a Notary Public, Commissioner for Declarations, Justice of the Peace or Academic Registrar of the institute which issued the transcript. Where qualications have been obtained under a different name, evidence of change of name must be provided (ie Marriage Certicate). Note copies can be faxed or emailed in the rst instance with certied copies required prior to being issued a CoE. If you are an overseas registered nurse, attach a certied true copy in English of your licence. Enclose certied copies of your English language qualication or details of English prociency. Enclose a certied photocopy of the personal details page of your passport and visa if applicable. If your academic transcripts are in a language other than English, enclose certied English translations. Enclose a research proposal. Enclose your c.v. and evidence of research attainments (e.g. publications). Enclose details of your home scholarship if applicable. Make a copy of your application for your records.

13. Declaration I hereby apply for enrolment in accordance with the Act, By-law, and Rules of The University of Newcastle and declare that: I understand that I must enrol in courses that comply with the requirements of the degree program to which I have been admitted I authorise the University to release information regarding my enrolment to Government agencies in accordance with legal requirements I understand that failure to pay fees and charges owed to the University or its partner organisation by the due date may result in my access to University services being restricted, the cancellation of my enrolment and/or action to recover any remaining debt I certify that all information and documentation supplied by me to the University is true, accurate and complete I consent to the collection, storage, and disclosure by the University, Universities Australia (UA) or any UA member institution of a record of any such information or any other irregular activity that may be considered to be untrue or misleading in any respect I agree to comply with the rules, policies and by-laws of the University of Newcastle I acknowledge and accept that the Code of Practice for Research Higher Degree Candidature describes the respective rights and responsibilities of both parties and forms the basis of understanding and commitment between the two parties I agree to abide by the Code of Practice for Research Higher Degree Candidature I understand that agreement to all of these terms is a condition of my enrolment at the University of Newcastle. Informed consent: I understand that the University of Newcastle is required by law to disclose information relating to any changes or breach of a student visa condition relating to satisfactory academic performance to the Department of Immigration and Citizenship (DIAC) I understand that the University of Newcastle is collecting the information in this form for the purpose of assessing my entitlement to Commonwealth assistance under the Higher Education Support Act 2003, and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me I understand that the University of Newcastle will disclose this information to the Department of Education, Employment and Workplace Relations (DEEWR) for the above purposes and that DEEWR will store the information securely in the Higher Education Information Management System (HEIMS) and that the information may be used in connection with the National Data Collection on University Applications and Offers and/or other collections as DEEWR may lawfully require from time to time I accept that DEEWR may disclose the information to the Australian Taxation Office (ATO), and that the University of Newcastle will not otherwise disclose the information without my consent unless required or authorised by law. In signing this form you are agreeing to all of the above conditions. Please note that giving false or misleading information is a serious offence under the Criminal Code (Commonwealth).

Signature Date Once you have completed the above, email, fax or send your completed application form to: International Admissions The University of Newcastle Callaghan NSW 2308 Australia T +61 2 4921 6595 F +61 2 4960 1766 E IA@newcastle.edu.au W www.international.newcastle.edu.au

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