EXPRESSION OF INTEREST
PROTICMonash-Oxfam Project for Information Empowerment in Bangladesh
For Potential Research Applicants PhD
Monash University CRICOS Provider Number 00008C /

Potential applicants to graduate research programs in Information Technology must complete this form before applying for admission. On the basis of the information provided in this Expression of Interest you may be invited to submit an online Application for Admission and/or Scholarship.

1. Personal Details
Monash Student ID Number:
(If applicable)
Family Name: / Title:
Given names:
Citizenship: / Domestic (Australian/New Zealand Citizen or Australian Permanent Resident)
International - please specify country of citizenship:
Have you previously applied for a program with the Faculty of Information Technology? / Yes / No
2. Contact Details

Please give contact details that are valid for at least one month after submission of this form.

Email:
Telephone:
3. Research Interests

Briefly outline your research interest in this project (200 words maximum).

·  The details you provide here help the school/institute expedite their assessment.

4. Academic Qualifications and Research Training Experience

Please list qualifications attained for all previous tertiary studies. Insert additional rows into the table as required

Duration (give expected completion date if incomplete) / Degree / Institution / GPA/Grade / % of Degree Completed by Research / Status (e.g. awarded/incomplete)

List all previous relevant research experience/employment. Insert additional rows into the table as required

Position / Duties / Employer/Institution / Duration
Start date: / / End date:
Start date: / / End date:

List your 10 most recent (or all) publications

Year / Title / Journal Reference

List any professional qualifications and memberships, awards and prizes, or additional relevant information

Year / Qualification/ Membership/ Presentation/ Performance /Award /Prize / Name and Location of Institution
5. English Language Proficiency

Proficiency in the English language is a requirement for admission.

Is English your first language?

Yes – please move to section 8
No – please complete below

Tick the appropriate box to indicate any English test you have completed within the last two years:

Academic IELTS
TOEFL

Please provide your results

Date completed / Overall test score / Reading / Listening / Writing / Speaking

Please note: test results are valid for two years from the date of the test, and must be valid when you commence your program. If you have not completed an appropriate English test within the past two years, please review the Monash University policy on English Language requirements and answer the question below.

Please specify if you have completed two years of tertiary study within the past five years at an accredited university where English is the language of instruction and assessment, and is an official language of that country (specify name of institution, dates of study and attach documentary evidence).

6. Scholarship Support

Tick all boxes that apply:

Yes / No
Yes / No
Yes / No
Yes / No
Yes / No

1.  Have applied for or been awarded a living allowance scholarship from another organisation to undertake studies at the Faculty of Information Technology, Monash University?

2.  I have applied for or been awarded a tuition fee scholarship from another organisation to undertake studies at the Faculty of Information Technology, Monash University?

3.  I wish to be considered for a living allowance scholarship?

4.  I wish to be considered for a tuition fee scholarship?

5.  I am self-funded and do not require any scholarship support?

Please list all scholarships applied for or awarded below. Insert additional rows into the table as required.

Name of scholarship / Sponsor/organisation / Value per annum
(Australian $) / Duration in total / Purpose(s)
(e.g. tuition fees, living expenses) / Status
(e.g. applied, awarded, expired)
7. Why do you want to do research at the Faculty of Information Technology, Monash University?

There are many reasons to choose Monash as the University for your Research Degree. Please outline the main reasons why you have selected to contact us (50-100 words maximum).

8. Statement by Applicant
I HAVE
Answered all questions on this form truthfully
I AGREE TO
×  Notify the Faculty of Information Technology of any change to the information I have given in this expression of interest
×  Permit the University to access my academic results from other institutions when assessing this expression of interest
I UNDERSTAND THAT
×  The University may vary or cancel any decision it makes if the information I have given is incorrect or incomplete
×  The University is not responsible for the loss of any documents submitted
×  Submission of this form does not guarantee acceptance to a graduate research program
×  Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth of Australia)
Full Name /

Signature

/
Date

EXPRESSION OF INTEREST ENDS HERE

Please:

Email an electronic copy of this form to

Privacy statement:

The information on this form is collected for the primary purpose of assessing your qualifications. Other purposes for collection include attending to administrative matters, corresponding with you and statistical analysis. If you choose not to complete all questions on this form it will not be possible for Monash University to assess your application. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact the University Privacy Officer on 9905 6011or: .

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