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Application for the Maurice de Rohan International Scholarship

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Please note: If you cannot fit all supporting information in the boxes provided (you will know you have run out of room when the scroll toolbar becomes activated), please attach further details.

Your personal details

Family name
Given name(s)
Student ID number
Current address for correspondence
Contact number Home Work Mobile
Emergency contact details Name                     
Relationship to student                     
Phone Fax
Email
Contact details while overseas Address

Phone Email
 

Your current enrolment details
Institute/School/Centre
Program code
Program name
Principal Supervisor
Research topic
 
Are you planning to undertake recreational travel in conjunction with this grant?   Yes
No
If Yes, what is the length of your additional stay?
Contact details
Written approval from the supervisor is required
 

Ethics
Does your research, study or project require ethics approval? Yes. If yes, you must have ethics clearance prior to travel. Please state date obtained:

No

Funding details
Scholarship held (if any)
Does this scholarship permit you to travel overseas? Yes
No
Other financial resources available to you for this overseas period of study  
Employment details (if any)
Previous financial assistance provided by UniSA for travel Yes
No 
If Yes, please provide details
Proposed budget for overseas travel grant
Return airfare   Conference fee (if applicable)
Accommodation   Health/travel insurance  
Food   Entertainment costs  
Local transportation   Gifts for host  
Telephone/Internet  
 		 Total budget  

Overseas research details
Details of overseas institution where the research or study will take place
and/or
Summary of location and duration of the proposed field trip
 
Principal academic staff member who will be supervising you while overseas
Name  
Phone   
Email  
Details of formal written confirmation Has approval been given by the overseas institution for the proposed period of study?
Yes. Confirmation details:
No. Please provide details when available by emailing research.travel@unisa.edu.au
Details of the research, data collection or study to be undertaken  
Statement of purpose (250-500 words)
Demonstrate how the overseas travel will add significantly to your research (for example, include the objectives and the outcomes you expect). You should also demonstrate that you have an awareness and understanding of cultural differences and are willing to perform the ambassadorial role that is required of the Maurice de Rohan international scholar.
 
 

Conference details (if applicable)
Note: Funding is not available solely to attend conferences
Conference title
Organising body
Venue
Accommodation address including country
Date
Details of refereed paper to be presented [Abstract to be attached]
Details of confirmation that the presentation has been accepted Yes. Confirmation details
No. Please provide details when available by emailing research.travel@unisa.edu.au
Discuss how the attendance at the conference will add significantly to your research
Indicate how you selected this conference and the country to be visited, the objectives of the presentation and the outcomes you expect, for example publications.

 

Itinerary
Proposed date of departure (flight number)  
Travel details
Date of return (flight number)
 
 

Supporting statements

Supporting statements are required from your Supervisor and the Research Degree Coordinator (or equivalent).

The statements are to address the following:

  • an appraisal of the HDR applicant in terms of the qualities listed below:
    • aptitude for independent research
    • communication skills
    • flexibility/adaptability to new situations
    • level of self confidence
    • maturity/independence
  • evidence that the overseas travel will add significantly to his/her research
  • if the HDR student will be presenting a conference paper and any publications expected
  • any reservations with regard to the HDR student's participation in the scheme.

Please copy and paste the following information into an email to the academic staff members (your Supervisor and Research Degree Coordinator) who are to complete the recommendation for you.

As part of the selection process, the Graduate Studies Office will seek comments from the Dean: Research (or equivalent).

Dear ...
Please find below the link to the Academic Recommendation form. Please complete this form recommending me for the Maurice de Rohan International Scholarship and submit to the Manager: Research Education and Training within 5 working days.

My details are:

Full name
Student ID
Home address
Home/Work/Mobile phone
Email address

Academic recommendation form (staff access only)

Supervisor's details
Name  
Title  
Division/Centre/Institute Other  
Contact details
Phone Fax
Email
 
 

Research Degree Coordinator's (or equivalent's) details
Name  
Title  
Division/Centre/Institute Other  
Contact details
Phone Fax
Email
 
 

Applicant's declaration

I undertake to return to UniSA to complete my research immediately following the completion of the purpose of my international travel as outlined in this application.

I agree to inform my Supervisor and the UniSA Graduate Studies Office if there is any change to the information that I have given in this application.

I agree to abide by the Conditions of Participation.

I understand that UniSA may vary or cancel any decision it makes if the information I have given is incorrect or incomplete and that I may have to repay any grant monies. I declare that the information provided in the application form and any attachments is complete, true and correct.
 

Conditions of participation

As a UniSA HDR student participating in this scheme, I understand that I remain subject to the policies, rules and regulations of the University of South Australia.

I also undertake to:

  • accept financial responsibility for all of my personal expenses, including accommodation, if applicable, during my time overseas
  • meet any pre-departure academic preparation specified by my Supervisor, Graduate Studies Office and UniSA International
  • arrange suitable travel, personal and medical arrangements and insurance provisions for myself
  • arrange for my University of South Australia tuition and other fees to be paid on my behalf each semester while I am away
  • abide by advice from the UniSA Graduate Studies Office regarding re-enrolment and review process
  • provide the UniSA Graduate Studies Office and Supervisor with contact details within one week of arrival at the host institution
  • fulfill my role as an ambassador for the University of South Australia, respect the culture, abide by the laws of the host country and by the regulations of the host institution
  • consult my Supervisor, Research Degree Coordinator or International Advisers promptly, and if necessary, consult the UniSA Graduate Studies office, should any problems arise in relation to my studies or otherwise during the international visit
  • submit a report on my overseas experience within four weeks of my return to UniSA and assist other outgoing students in their decision-making and planning to go overseas I understand that failure to abide by these conditions may result in disciplinary action by the University of South Australia and/or the host institution.
I accept the terms and conditions listed above Yes No
 

PRINT THIS FORM AND SEND TO GRADUATE STUDIES OFFICE

 

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