<p> IARU Global Summer Program 2017 Application Form ANU 1: Mobilising Research</p><p>Before completing your application, please ensure you have read the application requirements of the course(s) you are applying for. All fields are mandatory unless stated otherwise. Once you have completed the form, email to the ANU GSP Team at [email protected] by Wednesday 31 May 2017.</p><p>1. Personal Details</p><p>Home university Family name Given name Student ID Date of birth (dd/mm/yyyy) Nationality on passport Sex Male Female Term address (Address while at home university)</p><p>Permanent address</p><p>Telephone number Mobile/cell number (including country code) (including country code) Email address Please note that email will be used as the primary method of contacting applicants.</p><p>2. Special Requirements (optional)</p><p>Please let us know if you have special requirements so that we may make appropriate arrangements.</p><p>3. Emergency Contact Name Relationship to you</p><p>Telephone number Mobile/cell number (including country code) (including country code) Contact address</p><p>Email address</p><p>4. Academic Details</p><p>What is your degree program? What is your current year of study? What is your major?</p><p>What is your current GPA? (or equivalent) If English is not your native language, please provide evidence of English language proficiency. (such as TOEFL, IELTS or ‘O’ level English scores)</p><p>5. Statement of Purpose</p><p>Please write a brief statement of purpose (maximum 500 words) detailing your reason for applying to this course. Your statement of purpose should include what you hope to get out of the course, and what you are likely to contribute to the intellectual life of the program. You may like to include details of related courses you have previously taken, and / or the relevance of the program to your present course of study or professional development.</p><p>5. Statement of Purpose (Continued) 6. Other Information</p><p>Please include any extra-curricular involvement or experiences that may be relevant to your application, e.g. work experience, volunteer activities, community involvement, sporting / cultural achievements (maximum 500 words). 7. Declaration</p><p>I wish to apply to participate in ANU 1: Mobilising Research, as part of IARU Global Summer Program 2017, and declare that the information submitted in this application is correct and complete.</p><p>I agree to notify the ANU GSP contact if there is any change to the information I have provided in this application.</p><p>I authorize my home university to obtain official records from any institution I have attended, and acknowledge that my university reserves the right to vary or reserve any decision regarding nomination made on the basis of incorrect or incomplete information.</p><p>9. Application Information</p><p>Please make sure your application is complete: review the course profile to see if additional application material is required at this stage. </p><p>Please submit your completed application form via email to [email protected]. Please ensure that you have a copy of your application for your own records. </p><p>Application deadline: Applications must be submitted with supporting documentation to [email protected] by Midnight Wednesday 31 May 2017.</p><p>A complete application includes:  Application Form  Your most recent academic Transcript</p><p>Email these documents to [email protected] by midnight Wednesday 31 May 2017 in order to apply.</p>