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AUSTRALIAN FEDERATION of GRADUATE WOMEN Inc

APPLICATION FORM

Two (2) 2017 Barbara Hale Fellowships: Value $8 000 each

One (1) 2017 Georgina Sweet Fellowship: Value $7 000

There is a single application form for the Fellowships. The AFGW Selection Committee will determine the appropriate award for each recipient.

Closing Date:Midnight Eastern Standard Time (AEST) Wednesday, 31 May 2017

Eligibility: Available to women who are Australian citizens or permanent residents of Australiaand are enrolled for a PhD degree by research in any Australian university. The funds are to be used for a specific project or purpose for PhD research in any field.

Tenure (length)of proposed project from 01 October 2017: minimum six (6) months; maximum twelve (12) months

Guidelines: It is essential that youread the Guidelines before completing this form as they contain all necessary information.It should not be necessary to request extra information. All communication will be included in the assessment process.

Indicate which Fellowships you wish to apply for. You may apply for both.

AFGW Barbara Hale Fellowships

AFGWGeorgina Sweet Fellowship

Send the completed Application Form with relevant attachments to:

AFGW Fellowships

NAME:

Title / Dr Mrs Ms Miss
Family Name
Given Names / Preferred First Name
Date of Birth
Are you an Australian citizen? / Yes No / If not, are you a permanent Australian resident? / Yes No

OTHER DETAILS:

Mailing Address
Mobile Number / Telephone (H) (include area code)
E-mail Address

ACADEMIC QUALIFICATIONS(from most recent):

1 / 2 / 3
Year
Institution
Award
Surname conferred under (if different from that above)

CURRENT ENROLMENT:

Degree / Faculty/School / Institution
Degree (if different) for which theFellowship/s is sought) / Commencement Date / Expected Completion Date
Proposed Dates of the Project for which the Fellowship/s is sought (it must be part of the PhD research) / Commencement Date (must be after 01 October 2017 / Expected Completion Date
PhD Thesis/Project Title
Project Title
Describe how the project will enhance your PhD research
Summary of your research (limit of 800 words)
Purpose for which the Fellowship Funds would be used
Details of Budget (See Guidelines)
Other financial support already granted or for which you have applied
Additional brief information that may support your application: (Refer to Guidelines)
Name and Contact Details of Academic Referees (Refer to Guidelines)
Brief Summaryfor Publicity Purposes (refer to the guidelines)
Conditions of the Award / If successful,I agree to acknowledge a) the Barbara Hale or the AFGWFellowship by name and b) AFGW’sfinancial support in any publication (including any thesis) that results from the work undertaken
If successful,I will provide a report to AFGW on the conclusion of the project.
If I am forced to change my initial schedule because of unforeseen or unavoidable circumstances, I agree to obtain prior written approval from the AFGW Fellowship Officer.

Signature: (electronic or typed is acceptable) Date:

*** It is important to read and complete the Checklist on the next page.

*** Do not convert the application form to pdf.

CHECKLIST:NB: Applications must arrive by midnight AEST Wednesday, 31 May2017. Late applications will not be considered.

Ensure that you haveattached and/or included the following essential documentation: -

completed application form

your contact details

recent photograph in digital format

evidence of Australian citizenship or permanent residency

copy of your academic record and award of degree(s)

evidence of enrolment or acceptance

names and contact details of 2 referees

any other supporting information you wish to add (please keep this to a minimum)

brief summary of the project which may be used for publicity purposes.

agreement to the Conditions of the Fellowship

signature and date on the application form (typed signature is acceptable).