2015 PhD Scholarship Application Form

Application closing date is Sunday 4 October 2015 (midnight AEST)

This application form is accompanied by the 2015 PhD Scholarship Application Information document available from the Lowitja Institute website at www.lowitja.org.au/2015-phd-scholarship-application.

INSTRUCTIONS

·  Read the 2015 Scholarship Application Information document

·  Fill in this form

·  Combine all supporting documentation into a single Word or PDF file

·  To submit this application go to www.lowitja.org.au/2015-phd-scholarship-application

o  Complete the declaration on the website

o  Upload completed application form

o  Upload supporting documentation

o  Submit the Scholarship Application

No late or incomplete applications will be accepted; extension of time will not be granted. It is the applicant’s responsibility to submit their application by the due date. Applicants will receive an auto-generated email following submission. If this is not received within 24 hours, contact Tina McDonald on t: 03 8341 5516, e: .


APPLICATION FORM

This form has been prepared in MS Word, using a table format that will expand as content is inserted. Please do not delete or re-format any of the content such as questions or instructions.

Please comply with the word limits. Applications not complying with the word limits may not be considered. Text should be 12 point and the font Calibri.

Please note that, if you do not complete all relevant sections of this application or do not supply all the requested supporting documentation it will not be possible for the Lowitja Institute to process your scholarship application.

Application code [Lowitja Institute to insert]
Contact details
Title
First name
Last name
Date of birth
Phone
Mobile
Student email
Personal email
Home address
Postal Address
Aboriginality
☐ Aboriginal ☐ Torres Strait Islander ☐ Both
Proof of Aboriginality may be required if your application is successful
Enrolment details
Evidence of your enrolment will be required if offered a scholarship
Name of enrolling university
Campus location
Faculty/School
Title of enrolling PhD program
PhD commencement date
Proposed PhD completion date
Name of primary supervisor
Institution & campus
Phone
Mobile
Email
Name of secondary supervisor
Institution & campus
Phone
Mobile
Email
Include written confirmation from each supervisor in your supporting documentation.
Administering institution
Insert name of scholarship funds administering institution if different from university of enrolment.
Supporting academic information
Qualifications
Attach official documentation of your recent academic qualification/s – Institution, award, year, etc.
Curriculum Vitae
Attach a CV, maximum of 4 A4 pages
Academic Referees
Attach two academic references in support of your PhD research and scholarship application

Research activity details

Scholarship funding – I am applying for:
You may apply for a full-time PhD scholarship and/or research project funding, OR a top-up scholarship. Please see page 3 of the Scholarship Application Information document for more information.
Full-time PhD scholarship / ☐ 3 years ☐ 2.5 years ☐ 2 years
Research project funding / ☐ 3 years ☐ 2 years ☐ 1 year
Top up scholarship / ☐ 3 years ☐ 2 years ☐ 1 year
Other financial support
Provide the details of any other financial support you have applied for or have received
☐ Yes – I have applied for or have received other financial support
☐ No - I have not applied for or have received other financial support
Lowitja Institute program areas – proposed research best fits in which program area?
You may select more than one program area.
☐ Community capability and the social determinants of health
☐ Needs and opportunities for the Aboriginal and Torres Strait Islander health workforce
☐ Health and policy systems
Research activity title (maximum 20 words)
INSERT YOUR TEXT HERE
Research activity or question (maximum 100 words)
Briefly outline, in plain English, the central activity or research question of your PhD
INSERT YOUR TEXT HERE
Detailed research activity description – technical (maximum 1000 words)
Provide a detailed outline of the PhD research including details of the methodology, data collection and analysis, and the evaluation and impact measurement of the research.
INSERT YOUR TEXT HERE

Ethics

The Lowitja Institute is committed to the highest standards of integrity in research practice. As the national institute for Aboriginal and Torres Strait Islander health research, and being an Aboriginal and Torres Strait Islander organisation, it is incumbent upon us to demonstrate what integrity in research practice, and ethics, means for Aboriginal and Torres Strait Islander health research. The five principles that underpin the Lowitja Institute’s approach to ethical research are:

1. Benefit for Aboriginal and Torres Strait Islander people

2. Leadership by Aboriginal and Torres Strait Islander people

3. Engagement of research end users (Aboriginal and Torres Strait Islander organisations and communities, policy makers, other potential research users)

4. Development of the Aboriginal and Torres Strait Islander research workforce, and

5. Measurement of impact in improving Aboriginal and Torres Strait Islander people’s health.

This means that Aboriginal and Torres Strait Islander people must be meaningfully involved in the research and requires people to work together in genuine, transparent and mutually respectful partnerships. A Lowitja Institute Scholarship recipient’s PhD research will be required to demonstrate sound ethics practice. This process should be informed by:

·  National Statement on Ethical Conduct in Human Research 2007 www.nhmrc.gov.au/guidelines-publications/e72

·  Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research and the Guidelines for Ethical Research in Indigenous Studies www.nhmrc.gov.au/guidelines-publications/e52

·  Keeping Research on Track: A guide for Aboriginal and Torres Strait Islander peoples about health research ethics
www.nhmrc.gov.au/guidelines-publications/e65

Resources to support ethical practice can be found at the Lowitja Institute Ethics Hub at: www.lowitja.org.au/ethics.

How will Aboriginal and Torres Strait Islander people be involved in your research? (Maximum 300 words)
Outline the proposed involvement of Aboriginal and Torres Strait Islander people including academic leadership, community leadership and community organisations in the research.
INSERT YOUR TEXT HERE
Will your research require ethics approval?
☐ No – my PhD research will not require any ethics approval
☐ Yes – my PhD research will require any ethics approval
If Yes, outline the ethical approval process required for your research? (Maximum 300 words)
INSERT YOUR TEXT HERE

Knowledge exchange and research translation

The Lowitja Institute considers it is vitally important that our investment in research results in lasting positive impact on the health and wellbeing of Aboriginal and Torres Strait Islander people. Knowledge exchange refers to the process of mutual two-way learning between the research and those engaged in the research project. Research translation refers to the identification and facilitation of policy and/or practice outcomes based on the evidence generated through research. Our knowledge exchange approach is outlined on the Lowitja Institute website at www.lowitja.org.au/knowledge-exchange.

How will your PhD research contribute to knowledge exchange and knowledge translation during and as a result of your research? (Maximum 300 words)
Please consider the knowledge generated by your research activities and how these may be applied or engage others during your research and PhD program; and the development of any tools and resources; means of disseminating and publishing research findings; and any other activities for knowledge exchange.
INSERT YOUR TEXT HERE

Research benefit

The Lowitja Institute aims to work collaboratively with researchers to enable maximum benefit to Aboriginal and Torres Strait Islander people and communities from the research effort. The Institute is supporting development of tools and methodologies to assess the impact and benefit of research.

What do you perceive the likely benefits in health and wellbeing for Aboriginal and Torres Strait Islander people will be as a result of your research? (Maximum 200 words)
INSERT YOUR TEXT HERE

Intellectual property

The Lowitja Institute recognises the fundamental importance of identifying and classifying intellectual property (IP) developed from research activities funded by the Lowitja Institute CRC, as well as protecting background IP provided to research activities by Aboriginal and Torres Strait Islander people along with that of other participants in research collaborations. Applicants should be aware that, if they are successful in obtaining funding for their PhD research, IP will be discussed and negotiated to achieve an equitable outcome for all parties as part of the Institute’s general research funding agreement negotiations. If you require advice please contact Mr David Morgan, Chief Operating Officer, e: .

Is there any background IP to be brought to your PhD research?
Background IP is IP that was developed before the research commenced and that you will use in your research. Please identify any background IP that you will bring to your research. (Maximum 200 words)
INSERT YOUR TEXT HERE

Applicant’s declaration

Please complete this declaration as well as the online declaration when you submit this application.

I declare that the information supplied in this application is true and correct and that the listed supporting documents have been supplied. I have original copies of all submitted documents and I understand that the Lowitja Institute may request sighting the original documents for the purpose of verification. I acknowledge that all documents submitted will become the property of the Lowitja Institute and, as such, will not be returned to me.

Yes / No

I understand that the information collected in this application form will enable the Lowitja Institute to assess my application and, if my application is successful, create a legally binding Scholarship Agreement. I also understand that if I do not complete all relevant sections of this application or fail to supply all supporting documentation my application will not proceed.

Yes / No

I understand that it is a serious offence under the Criminal Code of the Australian Commonwealth to give misleading or false information and I acknowledge that the Lowitja Institute reserves the right to reverse any decision made about my scholarship application funding if it is found that I have provided misleading or false information.

Yes / No

Name
University of enrolment/intended enrolment
Administering institution
if different from university of enrolment
Date

Supporting documentation checklist

Ensure all supporting documentation meets the requirements of the application and correspondence from an institution must be on official letterhead. Allow sufficient time to obtain or prepare your supporting documentation:

1.  Evidence of your enrolment (if available or can be submitted when requested)

2.  Written confirmation of supervision from primary and secondary PhD supervisors

3.  Academic qualifications – official evidence of your current educational qualification/s

4.  Curriculum Vitae (maximum of 4 A4 pages)

5.  Two academic references

6.  Details of any other financial support you have applied for and/or have received.

Submitting the supporting documentation
All supporting documents must be combined into a single Word or PDF file (i.e. only one attachment is allowed)
PLEASE UPLOAD the supporting document file at
www.lowitja.org.au/2015-phd-scholarship-application

Receipt of application

Applicants will receive an auto-generated email following the submission of an application.

If you do not receive this email within 24 hours, please contact

Tina McDonald, Partner Engagement Officer t: 03 8341 5516 e:

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The Lowitja Institute PhD Scholarship Application 2015