<p> Joint Research Centre of Grains for Health Domestic Student PhD Application Form</p><p>Email completed form with attachments to Iain Searle [email protected]</p><p>SECTION 1 – PERSONAL DETAILS</p><p>Full name</p><p>Gender</p><p>Date of Birth (DD/MM/YYYY) Please select from the following, are you: An Australian citizen A New Zealand citizen An Australian permanent resident</p><p>Country of Birth</p><p>Permanent address in Australia</p><p>Suburb Post code</p><p>Email Address</p><p>Contact phone number</p><p>Mobile phone number</p><p>SECTION 2 – PROGRAM DETAILS</p><p>Please provide your top three preferences for First preference ______research areas that most interest you Second preference ______</p><p>Third preference ______SECTION 3 – TERTIARY QUALIFICATIONS (e.g. BSc, BSc (Hons), MSc etc)</p><p>Qualification 1</p><p>Institution</p><p>Country</p><p>Year Year commenced completed</p><p>Qualification 2</p><p>Institution</p><p>Country</p><p>Year Year commenced completed</p><p>Qualification 3</p><p>Institution</p><p>Country</p><p>Year Year commenced completed</p><p>Qualification 4</p><p>Institution</p><p>Country</p><p>Year Year commenced completed</p><p>*Please attach additional sheets, if required SECTION 4 – RESEARCH/EMPLOYMENT EXPERIENCE</p><p>Position 1</p><p>Employer</p><p>Country</p><p>Year Year commenced completed</p><p>Position 2</p><p>Employer</p><p>Country</p><p>Year Year commenced completed</p><p>Position 3</p><p>Employer</p><p>Country</p><p>Year Year commenced completed</p><p>Position 4</p><p>Employer</p><p>Country</p><p>Year Year commenced completed</p><p>Position 5</p><p>Employer</p><p>Country</p><p>Year Year commenced completed</p><p>*Please attach extra sheet if needed SECTION 5 – DETAILS OF YOUR RESEARCH BACKGROUND</p><p>Based on your highest degree Did your highest degree require you to undertake research and / or produce a formal thesis/dissertation? </p><p>Yes</p><p>No</p><p>If yes, what proportion of your study was allocated to your research thesis/dissertation? </p><p>Months (full-time) ______</p><p>Total course in months ______</p><p>Please enter the results/grade received for your thesis:</p><p>GPA %</p><p>Do you have any publications? Yes No</p><p>If so, how many: ______</p><p>SECTION 6 – ENGLISH LANGUAGE PROFICIENCY</p><p>If your first language is not English, you may be required to provide an English certificate. Please indicate how you meet the language requirements:</p><p>IELTS (academic) test (Undertaken in the 24 months preceding application)</p><p>Date ______</p><p>Overall score ______</p><p>TOEFL test (Undertaken in the 24 months preceding application)</p><p>Date ______</p><p>Overall score ______</p><p>First language is English SECTION 7 – FUNDING</p><p>PhD students must ensure they have sufficient funds for living costs in Adelaide. Please indicate your source of financial support while studying at the University of Adelaide:</p><p>Self Family Loan Sponsor*</p><p>I have no funding, but am willing to apply for a scholarship by:</p><p>University of Adelaide</p><p>FOODplus Research Centre</p><p>*Name of sponsor ______</p><p>SECTION 8 – DOCUMENTATION</p><p>Please provide a copy of the following documents as an attachment to your email:</p><p> Letter of interest (written by you)  Resume/CV (including the details of at least two professional referees and any research publications)  Scanned copy of academic transcript results (include an explanation of the grading system used and a translation in English if applicable)  Scanned copy of IELTS/TOEFL scores (if applicable – for more details visit http://www.international.adelaide.edu.au/apply/admission/)</p>