Higher Degree by Research Scholarship Application Form

HIGHER DEGREE BY RESEARCH SCHOLARSHIP APPLICATION FORM

1. Please select the type of scholarship you wish to be considered: (You may choose more than 1 option)

☐ Full Scholarship (Tuition fee waiver and monthly stipend) ☐ Tuition Waiver Scholarship (tuition fee waiver only)

2. Please indicate if you will consider Monash University Malaysia’s offer for admission if you are NOT successful in securing the scholarship(s) selected above offered by Monash University Malaysia. ☐ YES ☐ NO

SECTION 1: APPLICANT’S PARTICULAR

Name Click here to enter text.

IC no./Passport no. Click here to enter text.

Permanent Home Address Click here to enter text.

Mailing address Click here to enter text. (if different from permanent home address)

Home telephone no. Click here to enter text. Mobile telephone no. Click here to enter text.

E-mail address (if any) Click here to enter text.

Have you ever been enrolled in Monash University? ☐ YES ☐ NO If yes, please provide your Monash ID Click here to enter text.

SECTION 2: DETAILS OF THE COURSE FOR WHICH SCHOLARSHIP SUPPORT IS SOUGHT

School/Platform Choose an item.

Course applied/enrolled Click here to enter text.

Intake semester (full-time only) Click here to enter text./2016

Supervisors (if known) Click here to enter text. SECTION 3: EDUCATION INFORMATION

1. Please list your qualifications below No Name of Degree Awarding institution Commencement and Grade completion date 1 Click here to enter text. Click here to enter text. Click here to enter Click here to enter text. text. 2 Click here to enter text. Click here to enter text. Click here to enter Click here to enter text. text. 3 Click here to enter text. Click here to enter text. Click here to enter Click here to enter text. text. 4 Click here to enter text. Click here to enter text. Click here to enter Click here to enter text. text. 5 Click here to enter text. Click here to enter text. Click here to enter Click here to enter text. text.

2. Please state your English Proficiency Test below No Name of Test Completion date Grade 1 Click here to enter text. Click here to enter a date. Click here to enter text. 2 Click here to enter text. Click here to enter a date. Click here to enter text.

SECTION 4: RESEARCH EXPERIENCE

1. Describe briefly your research experience Click here to enter text.

2. Please list your publications (journals, conference papers, book chapters, book, monographs, etc - if any) No Title Author(s) Publication name Year Vol/Issue 1 Click here to Click here to enter Click here to enter text. Click Click here enter text. text. here to to enter enter text. text. 2 Click here to Click here to enter Click here to enter text. Click Click here enter text. text. here to to enter enter text. text. 3 Click here to Click here to enter Click here to enter text. Click Click here enter text. text. here to to enter enter text. text. (You may attach a separate list if you have more than 3 publications) SECTION 5: AWARDS

1. Have you ever received any award(s) ☐ YES ☐ NO

2. Please list the award(s) if you have received any No. Award name Institution Year 1 Click here to enter text. Click here to enter text. Click here to enter text. 2 Click here to enter text. Click here to enter text. Click here to enter text. 3 Click here to enter text. Click here to enter text. Click here to enter text. 4 Click here to enter text. Click here to enter text. Click here to enter text. 5 Click here to enter text. Click here to enter text. Click here to enter text. (You may attach a separate list if you have more than 5 awards)

SECTION 6: EMPLOYMENT DETAILS RELEVANT TO YOUR POSTGRADUATE RESEARCH TOPIC

Employer #1

Company/Organisation/Institute Click here to enter text.

Address Click here to enter text.

Position Click here to enter text.

Period of employment Click here to enter a date. to Click here to enter a date.

Employment status ☐ Full-time ☐ Part-time

Are you currently employed by this company? ☐ YES ☐ NO

Employer #2

Company/Organisation/Institute Click here to enter text.

Position Click here to enter text.

Period of employment Click here to enter a date. to Click here to enter a date.

Employment status ☐ Full-time ☐ Part-time

Are you currently employed by this company? ☐ YES ☐ NO SECTION 7: ACADEMIC REFEREES

Please provide details of 2 academic referees who are familiar with your academic background

Referee #1

Academic relationship Click here to enter text.

E-mail address Click here to enter text.

Telephone no. Click here to enter text.

Fax no. Click here to enter text.

Referee #2

Academic relationship Click here to enter text.

E-mail address Click here to enter text.

Telephone no. Click here to enter text.

Fax no. Click here to enter text.

SECTION 8: CHECKLIST

☐ Copy of School Invitation Letter ☐ Certified True Copies of official academic records and English Language Proficiency Test results ☐ Copies of application fee receipts (if applicable) ☐ Copy of Identity Card/Front Page of Passport ☐ Copies of other relevant documents e.g. academic prizes, research experiences, publications, etc SECTION 9: DECLARATION

I, the undersigned, do hereby declare that the information given by me in this form is correct to the best of my knowledge. I authorise the release of this application and supporting documents to appropriate persons within Monash University Malaysia in confidence as part of any selection process for scholarship which might follow and accept the final decision of the Scholarship Awarding Committee. I agree to abide by the University’s conditions of award and course regulations and rules, where applicable.

Signature: Date: Click here to enter a date. (You may insert a digital signature or print and sign on the hardcopy)

Name: Click here to enter text.

Please return the completed application form via the following methods:

E-mail a word or pdf copy to [email protected]

Mail or courier to: Scholarship Campus Research Management Monash University Malaysia Jalan Lagoon Selatan Bandar Sunway, 46150 Petaling Jaya, Selangor Darul Ehsan MALAYSIA Telephone: +603-5514 6000 For Office Use Only

Received by CRM

Name: Date: Signature:

Scholarship round ______

Documents submitted by applicant are complete?  Yes  No ______Referee report received?  Yes  No ______

Processed by School HDR Committee/Platform Selection Committee

Remarks:

Is the candidate supported by external funded stipend? ☐ YES ☐ NO

______

Processed by Campus HDR Committee

Remarks:

______

Issuance of letter by CRM/School/Platform

Candidate’s acceptance date: