Citizenship Status: Australian citizen Permanent Residents only citizen Date residency granted: Permanent Resident of Did you meet residency requirements (but not an Australian citizen) for citizenship more than one year ago? Yes No Holder of a student visa, temporary Will you be residing in during resident visa or visitor visa Yes No None of the above the study period? Year of Main language Country of (to ) spoken at (if not ) home Aboriginal or Islander status: Aboriginal Both Aboriginal and TSI Islander None of the Disabilities: Do you have a disability or medical condition which may affect your No Yes studies? If please indicate below any disability that applies. “Yes”, Hearing Learning Medical Vision Mobility Other Would you like information on support services? Yes No Academic Details Degrees and Awards: Original or certified copies of academic transcripts, showing all subjects attempted and grades received, except for studies undertaken at Flinders University, MUST be attached to this application. Are you currently enrolled/previously been enrolled in a research higher degree? No Yes (provide details below) List in chronological all university or other post-secondary courses attempted or completed. Attempted but not Completed or Name of Degree/Award Institution Major Field of Study completed. about to year last enrolled complete. Enter year last enrolled Research Experience: A brief summary of your research experience must be attached. Include details of any publications, research grants, patents, creative works or employment experience relevant to your proposed research project. Academic referees: Provide the and contact details of two academic referees. Nominated academic referees should have an informed, personal and professional knowledge of your academic ability and should be able to exercise judgement of your research potential. It is recommended that you select the supervisor of the most recent tertiary program in which you are/were enrolled or the Dean of Department or the Postgraduate Coordinator of the Department. First Referee Second Referee Name Name Position Position Address Address Email Email 2
Citizenship Status: Australian citizen citizen Permanent Resident of (but not an Australian citizen) Holder of a student visa, temporary Permanent Residents only Date residency granted: Did you meet residency requirements for citizenship more than one year ago? Will you be residing in during Yes No resident visa or visitor visa None of the above Yes No the study period? Country of (if not ) Year of (to ) Main language spoken at home Aboriginal or Islander status: Aboriginal Both Aboriginal and TSI Islander None of the Disabilities: Do you have a disability or medical condition which may affect your studies? If “Yes”, please indicate below any disability that applies. No Yes Hearing Learning Medical Vision Mobility Other Would you like information on support services? Yes No Academic Details Degrees and Awards: Original or certified copies of academic transcripts, showing all subjects attempted and grades received, except for studies undertaken at Flinders University, MUST be attached to this application. Are you currently enrolled/previously been enrolled in a research higher degree? No Yes (provide details below) List in chronological all university or other post-secondary courses attempted or completed. Name of Degree/Award Institution Major Field of Study Attempted but not completed. year last enrolled Completed or about to complete. Enter year last enrolled Research Experience: A brief summary of your research experience must be attached. Include details of any publications, research grants, patents, creative works or employment experience relevant to your proposed research project. Academic referees: Provide the and contact details of two academic referees. Nominated academic referees should have an informed, personal and professional knowledge of your academic ability and should be able to exercise judgement of your research potential. It is recommended that you select the supervisor of the most recent tertiary program in which you are/were enrolled or the Dean of Department or the Postgraduate Coordinator of the Department. First Referee Second Referee Name Name Position Position Address Address Email Email 2
RHD%20Admission%20form%20-%20Nov%202015.docx