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APPLICATION FOR POSTGRADUATE RESEARCH SCHOLARSHIPDR SUSAN HOLLAND SCHOLARSHIP• You must provide responses to all questions on the form itself. Although supporting documents may be attached to amplifysummarised information the selection panel will not undertake to retrieve information in response to such commentsas ‘See attached CV’.• Once completed, this form should be printed before signing. We must receive the original signed form, not anemailed copy.APPLICANT DETAILS:Title: Mr Ms MissSurname:Given Name(s):MrsOther:Correspondence Address: Date of Birth: / /Permanent Home Address (if same ascorrespondence address print ‘as above’):Email:Telephone (pref): Telephone: Facsimile:Are you currently enrolled at ECU?Please note that this form is for Scholarship only and will not be considered for admission.Please contact the Research Admissions Officer on 6304 3434 or hdr.enquiries@ecu.edu.aufor a separate Application Form.Student Number:Are you a fee-paying Overseas Student (ie, Do you hold a temporary residence visa)?If YES, you are not eligible for this scholarship.YesYesNoNoCURRENT COURSE DETAILS:Course: Doctor of Philosophy Master by Research(589) (670)Course Code:Discipline of study (ie, human biology, education):School and Faculty :EducationSchool of EducationIf granted a scholarship, when would you intend to take it up? Semester 1, 201 OR Semester 2, 201Successful scholarship applicants are normally expected to commence in semester one.I understand that if I am offered a scholarship it will be for full-time study, unless exceptional circumstances apply If youare not offered a scholarship but are offered a course place then you may enrol on a full-time or part-time basis.I understand that if I am offered a scholarship it will be for on-campus study.Scholarship Office http://www.ecu.edu.au/ecu-scholarships/overviewemail: scholarships@ecu.edu.au

QUALIFICATIONS:PLEASE NOTE: For each of the courses you have listed below you must enclose certified copies of your academic recordAND translated documents if the original is not in ENGLISH (you do not need to include qualifications obtained at ECU).Please list all tertiary courses (eg Bachelor, Honours, Master) you have already completed.Year lastenrolledName of InstitutionCourse Title(eg Bachelor of Science)CurrentlyEnrolled?CourseCompleted?Proposed Date ofCompletion (ifapplicable)PhD orMasters byResearch?YES NO YES NO Semester Year YES NOEquivalentfull-timeenrolmentcompleted(semesters)## NOTE: If you have completed or enrolled previously in a research masters or Doctor of Philosophy please indicate the equivalentfull-time semesters of enrolment.POSTGRADUATE QUALIFICATIONS:If you hold a Masters degree please complete the following.Please ensure that you attach certified academic transcripts showing units completed.Name of Course:Normal duration (full-time equivalent) in years:Number of research methodology units:Institution:Number of research thesis/project units:Number of other coursework units:Number of semesters (full-time equivalent) of thesis preparation & development:Number of semesters (full-time equivalent) of coursework units:Final Grade or average coursework mark:RESEARCH EXPERIENCEGive the title and length of any theses or dissertations you have submitted for an academic qualification (indicate coursetitle and year of completion):Have you undertaken any research OTHER than that required for your academic qualifications? Yes NoIf YES, state the length and scope of each project and briefly describe your role:Length of time: years monthsProject:Your role:Have you won any research grants? Yes NoIf YES, give details including AMOUNT, PROVIDER and SCOPE of the project funded (attach copies of relevant sections ofcontracts or letterhead correspondence):Has any of your research been published? Yes NoIf YES, attach a separate sheet, which lists your publications under the following headings (giving the full bibliographicalreference for each, including full authorship, and attach verification documents as indicated below):Scholarship Office http://www.ecu.edu.au/ecu-scholarships/overviewemail: scholarships@ecu.edu.au

Note: English translations must be provided for foreign language publications.1. Research Books Authored research books, published by a recognised commercial publisher.Verification Documents: Attach copies of Table of Contents, flyleaf, preface, introduction and published first page2. Research Book ChaptersVerification Documents: Attach copies of Table of Contents, flyleaf, preface, introduction and published first page3. Refereed Journal Articles or Refereed Conference PapersVerification Documents: Attach proof of refereeing, copy of article, flyleaf of journal giving full publication details4. Non-Refereed Publications Conference papers, poster presentations, invited seminars, product specificationsVerification Documents: Attach copies of conference programs, abstracts, and appropriate evidence alternative research output.5. Creative WorksVerification Documents: Attach copies of exhibition catalogues, theatre programs, correspondence confirming selectionfor exhibition, performance or publication, peer reviewed articles.6. Research Experience active role in research projectsVerification Documents: Attach copies of correspondence confirming research role, project and period involved.7. Research GrantsVerification Documents: Attach copies of correspondence confirming amount of grant, funding body, number of people involved inthe project and applicant’s role.RELEVANT WORK EXPERIENCEPlease list any relevant work experience. Additional information may be provided in a Resume or Curriculum Vitae.Employer/Institution Dates Position/DutiesPROPOSED THESIS TOPICHave you approached or identified a potential supervisor?* Yes NoIf YES, please name:*Please note: due to the number of applicants there is no guarantee of supervision. Supervisors will be determined by the Facultyonce all applications have been assessed.Briefly outline the proposed research topic. Include the questions you wish to explore; relevant literature in the proposedarea and/or gap in literature you are addressing; and your proposed methodology (PhD Application – Maximum 2 pages inlength; Master by Research – Maximum 1 page in length).Please attach a separate sheet if you are working from a printed form.OTHER SCHOLARSHIPSHave you previously have received an APA, APA(Industry) or Australian Government-fundedpostgraduate research award?YesNoIf YES, please provide details (include name of scholarship, awarding body, amount and other details):Was this awarded terminated within six months of commencement? Yes NoAre you currently receiving any other scholarships? Yes NoScholarship Office http://www.ecu.edu.au/ecu-scholarships/overviewemail: scholarships@ecu.edu.au

If YES, please provide details (include name of scholarship, awarding body, amount and other details):When is this scholarship due to expire?ADDITIONAL INFORMATIONPlease provide information regarding membership of professional associations, prizes awarded etc. and any other relevantdata:ACADEMIC REFEREESReferees should be a senior academic who is conversant with your most recent studies, particularly that undertaken byresearch.Please note that it is your responsibility to forward Academic Referees Report forms to your referees and for following up their returnto the Research Scholarships Officer.Special circumstances: If you are unable to provide these, please note on the application form.Essential Scholarship applications.Name:Position/Title:Institution:Address:Telephone:Email:Name:Position/Title:Institution:Address:Telephone:Email:DECLARATIONI declare that the information provided by me in this application is true and correct. I acknowledge that Edith Cowan University reserves the right to make suchenquiries as may be reasonable necessary to verify the information provided by me in this application including, with regard to my educational qualifications.I understand that providing false and misleading information to obtain admission and/or credit into a course is an offence.I confirm I have made my own enquiries as to the suitability of the course that I am seeking to be enrolled; andI confirm that it is my sole responsibility to ensure that my enrolment is in accordance with the Admissions Enrolment and Academic Progress Rules of EdithCowan UniversityI acknowledge and agree that the information provided by me to Edith Cowan University may be provided to Commonwealth and State agencies when requiredby law.If I am admitted into a course with Edith Cowan University, I agree to comply with the Statutes, By-Laws, Rules and Regulations of Edith Cowan University.I acknowledge I have had the opportunity to peruse the Statutes, By-Laws, Rules and Regulations of Edith Cowan University at:http://www.ecu.edu.au/GPPS/governance_services/legislation.html.I acknowledge that official communication by Edith Cowan University to me will be by electronic means unless alternative communication arrangements havebeen agreed by ECU.I agree to access the contents of my Edith Cowan University e-mail account on a regular basis.I agree to notify Edith Cowan University of any changes to my residential addresses whether in Australia or another country and to any change in the contactinformation in the event of an emergency.I understand that if any information is found to be false this application may be cancelled.I agree to abide by the conditions of the scholarship as amended from time to time.Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth).Signature of applicant: Date: / /CHECKLISTHave you complete the following steps?Completed all sections of this form?Scholarship Office http://www.ecu.edu.au/ecu-scholarships/overviewemail: scholarships@ecu.edu.au

Printed this form and signed the Declaration above? Please return this form with an original signature. Do not email the form.Attached CERTIFIED* copies of all your qualifications and academic transcripts, including proof of English competency (ifapplicable)?Attached CERTIFIED* copy of your Australian Birth Certificate, residency or citizenship?Attached documentation translating any non-English academic qualifications &/or research output into English (if applicable)?Provided a separate list of your publications in the format specified and attached all the required verification documents?Attached your CV, resume or employment/academic history?Requested academic referee report forms to be completed and sent to the Research Scholarships Officer by the due date?* Documents can be certified by any Australia university or the official records department of the institution that originallyissued the documents. For information on other parties that can certify documentation please refer to the Advice toApplicants documentation.IT IS THE RESPONSIBILITY OF THE APPLICANT TO PROVIDE ALL REQUIRED PAPERWORK FOR THISAPPLICATION.CHECK WEBSITE: http://www.ecu.edu.au/ecu-scholarships/overview FOR CLOSING DATESNO LATE APPLICATIONS WILL BE ACCEPTED.Send your completed applications and associated documentation to:Research Scholarships OfficerScholarships Office, Edith Cowan University270 Joondalup DriveJOONDALUP WA 6027Scholarship Office http://www.ecu.edu.au/ecu-scholarships/overviewemail: scholarships@ecu.edu.au