AUSTRALIA-AMERICAS PhD RESEARCH INTERNSHIP PROGRAM
APPLICATION FORM
Applications close 23:59 (EST) Friday, 19 January 2018. Please submit your application as a PDF (scanned copy with signatures) to international_admin@science.org.au 
Applicant details
Title	First name 	Surname	

US home institution		
Postal address		
Email address		
Phone number (incl. area code)	Business hours 	Mobile	

Date of birth		
Country of birth		
Gender		
Research area		
Proposed research topic		

Applicant eligibility
Tick the most relevant box in this category	Applicants must be either:
 	a US citizen
 	a US permanent resident	
Tick the most relevant box in this category	Applicants must be either:
 	in the second year of a PhD program
 	in the third year of a PhD program	
	Applicants must confirm:
 	an allowance for international travel and domestic travel in Australia (~$AU3,500) will be provided by my home institution if my application is successful	

Academic background
Please list all relevant academic qualifications you have achieved that relate to your current area of study:
Qualification	Institution (include country)	Date(s)	

			

Professional background
Please list any relevant professional positions held since completing your tertiary education that you would like to mention and outline your key responsibilities:
Position held	Employer (include country)	Date(s)	

			

Referee contact details (in the US)
Please provide contact details of a referee (note, this should be your PhD supervisor in the US):
Title and name		
Position		
Correspondence address		
Email address		
How long have you known this referee		

Host contact details (in Australia)
Please provide contact details of your Australian host:
Title and name		
Position		
Institution		
Email address		
Telephone number (business hours)		
Correspondence address		
Signature of host		

Response to the selection criteria
1.	Well defined research program in Australia, explaining the methodology and proposed steps for practical implementation (maximum 500 words) (40%)

2.	Written statement about how the research internship will progress the bilateral relationship between Australia and the US and strengthen research collaboration (maximum 250 words) (20%)

3.	Statement on how participating in the program will further the applicant’s academic and professional career (maximum 250 words) (10%)

4.	Academic achievement; awards, patents and publications in the chosen field of study; extra-curricular projects and activities and any relevant work experience (maximum 250 Words) (10%)

5.	Endorsement from the home institution (from the applicant’s PhD supervisor) with regard to the applicant’s leadership, research and networking skills (maximum 500 words) (10%). The endorsement should take the form of a letter (on letterhead) signed by the applicant’s PhD supervisor and be attached to this application as a supporting document. 

6.	Letter of recommendation from the from the host institution (identified host researcher) recommending the applicant for the internship and referencing the potential for further collaboration (maximum 500 words) (10%). The statement should take the form of a letter (on letterhead) signed by the applicant’s identified host researcher and be attached to this application as a supporting document. 

How to apply
APPLICATION DEADLINE – 23.59 (EST), Friday, 19 January 2018.
Completed applications, including application checklist and supporting documentation, must be submitted electronically in PDF format, to international_admin@science.org.au. 
The following supporting documents must be submitted with your application (in the following order)
1.	Enrolment letter from a US institution that offers a PhD program in one of the eligible research fields
2.	Proof of US citizenship/permanent residency (eg, passport, birth certificate, permanent resident card)
3.	Academic transcript for current degree
4.	Supporting documents that attest to the qualifications mentioned at the fourth selection criterion
5.	Letter of endorsement from the home institution (PhD supervisor) 
6.	Letter of recommendation from the host institution (identified host researcher)
NO LATE APPLICATIONS WILL BE CONSIDERED	

AUSTRALIA-AMERICAS PhD RESEARCH INTERNSHIP PROGRAM
GUIDELINES FOR APPLICANTS
Deadline for applications: 23:59 (EST) Friday, 19 January 2018
Confirm eligibility
•	An allowance for international travel and domestic travel in Australia (~$AU3,500) will be provided by my home institution if my application is successful

Attach Application checklist (please tick box ü upon completion) 
•	Complete, sign and attach this application checklist form

Attach US application form:        
•	Complete and submit the application form and supporting documents to: international_admin@science.org.au 

Attach supporting documents in the following order
•	Enrolment letter from a US institution that offers a PhD program
•	Proof of US citizenship/permanent residency 
•	Academic transcripts
•	Supporting documents that attest to the qualifications mentioned at the fourth selection criterion 
•	Letter of endorsement from the home institution (PhD supervisor) 
•	Letter of recommendation from the host institution (identified host researcher)

Submit Australia-Americas PhD research internship program 
•	Complete and submit the application form and supporting documents to: international_admin@science.org.au by 23:59 (EST) Friday, 19 January 2018
I hereby certify all information is true and correct to the best of my knowledge. 

______________________________            __________
Signature of applicant                                     	Date signed

Name in Block letters     ______________________________________________________
Receipt of application form:	Your application will be acknowledged within 48 hours following the grant deadline. If you do not receive acknowledgement that this application has been received please contact international_admin@science.org.au immediately. No late applications will be considered.
Notification of outcome:	The Academy expects that all applicants will be notified of the outcome by 28 February 2018.
Contact:				international_admin@science.org.au