The Clare Burton Scholarship 2018

THE CLARE BURTON SCHOLARSHIP 2018 APPLICATION FORM

For postgraduate research into gender equity within one of the 5 universities of the Australian Technology Network (ATN):

 Curtin University (Perth)  Queensland University of Technology (Brisbane)  RMIT University (Melbourne)  University of South Australia (Adelaide)  University of Technology Sydney (Sydney)

Please refer to the Scholarship Guidelines for full details.

1. APPLICANT DETAILS

Family Name: Given name(s):

Title:

Address:

Telephone: Mobile:

Email:

Are you an Australian resident? Yes No

2. ENROLMENT/COURSE DETAILS

(a) Are you currently an enrolled post-graduate student? Yes No

(b) If yes, at which institution?

(c) If no, at which ATN university do you propose to enrol in 2018? (Curtin, QUT, RMIT, UniSA, UTS)

(d) In what program/course do you propose to enrol in 2018? (e) Is your 2018 enrolment confirmed? Yes No

(f) Student Number (if known)

Note: The applicant should attach evidence of confirmation of enrolment, or forward such evidence as soon as possible. 3. RESEARCH PROPOSAL

Outline your research proposal. Please indicate:

 its aim;  the potential significance of its results;  the methods or techniques you will use; and  the expected timeframe.

(Please attach maximum of 2 pages). NOTE: Proposals longer than 2 pages (Calibri, size 12 font) will not be considered by the review panel. This guideline will be adhered to strictly.

4. RESEARCH BACKGROUND

(a) Provide evidence of your skills and experience in academic study and research (e.g. academic record). Attach, if necessary.

(b) Outline your involvement with, and commitment to, gender equity. Refer to your activities and experience including academic work, consultancies, volunteer work, and community service, membership of relevant groups or associations or engagement in public policy formation.

(c) Provide the names and contact details of two referees who could comment on the above information, and on your capability as a researcher.

5. PERSONAL CIRCUMSTANCES (Optional) 2 If you wish to make a claim in this area, please fill out one or more sections below. Any information you provide here will be treated in the strictest confidence. It may be used in the selection process to distinguish between two applicants of equal merit.

(a) Income and Expenditure:

Please give an indication of your current annual income and expenditure, including that of any dependants. Include both living and study expenses in your estimation. You may provide details, if you wish, of the number of dependants and their ages, whether you are a sole carer, and whether your dependants have special needs. You should indicate if you or your family have been issued a Health Care card or rely on a pension or unemployment benefit. Please also indicate if you will be in receipt of another scholarship or bursary in 2014. (Please attach appropriate evidence in support of your claims such as: taxation assessment, Health Care Card, Austudy Statement, or similar)

(b) Please indicate if any one or more of the following applies to you:

Indigenous person

Living in a rural or isolated area

Non-English-speaking background (NESB) Female, in a non-traditional area of study (one in which women are significantly under-represented) Person with a disability

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(c) Has your academic/research career been adversely affected or interrupted by circumstances such as illness, childbearing, childrearing, caring for other dependants such as parents, or other circumstances? Please give brief details.

6. DECLARATION

I declare that the details provided in this application are, to the best of my knowledge, true and correct.

Signed:

7. SUBMITTING THE APPLICATION

Please send an electronic copy of your application to:

Alec Webb, Senior Policy Analyst, ATN Phone: 08 8302 0389 Email: [email protected]

To arrive no later than COB AEDT Friday 20 October 2017