Fra||
|oo||e
0a|e | |
24. +pplicantHs aut%orisation@ a"reement@ declaration and si"nature)
28
+ut%orisation
AusAl0 rus| corp|y W||| ||e Privacy Act AHFF |r re|a||or |o ||e persora| |rlorra||or you |ave prov|ded |r |||s lorr.
8y suor||||rg |||s lorr l au||or|se AusAl0, or ||s appo|r|ed rarag|rg cor|rac|or, |o access ard|or oo|a|r |rlorra||or,
|rc|ud|rg cop|es ol ary ol ry re|evar| acader|c records|repor|s lror ||e Aus|ra||ar ur|vers||y(s) ||a| l |ave a||erded lor
||e lo||oW|rg purposes.
lor use |r ||e se|ec||or process lor ar Aus|ra||a AWard
|o ror||or ry acader|c perlorrarce a| ry |os| ur|vers||y W|||e s|udy|rg urder ar Aus|ra||a AWards
3c|o|ars||ps
|o or|el re|evar| Aus|ra||ar oll|c|a|s, ||r|s|ers ard reroers ol lar||arer|.
3|ou|d l rece|ve ar Aus|ra||a AWard, l corser| |o ||e Aus|ra||ar 0overrrer| us|rg ard d|sc|os|rg ex|rac|s ol ry
app||ca||or (re|a||rg |o ry acader|c oac|grourd ard ac||everer|s, |eaders||p s||||s ard ry proposed s|udy prograr |r
Aus|ra||a) |r proro||ora| ra|er|a| |r |ardcopy ard or ||e lr|erre|. l ro|e ||a| proro||ora| ra|er|a| ray |rc|ude, ou| |s ro|
||r||ed |o, red|a re|eases ard |rlorra||or c|rcu|a|ed |o AusAl0's olls|ore los|s ard Aus|ra||ar ur|vers|||es, corcerr|rg ||e
Aus|ra||a AWards 3c|o|ars||ps.
l au||or|se AusAl0 |o d|sc|ose ||e persora| |rlorra||or co||ec|ed |r |||s lorr |o o||er Aus|ra||ar 0overrrer| depar|rer|s
lor ||e purpose ol proro||rg ard rarag|rg ||e Aus|ra||a AWards 3c|o|ars||p.
6nderstandin"
l urders|ard ard corl|rr ||a|.
l |ave read ard corp||ed W||| ||e 3c|o|ars||ps lardooo| ard ||a| ||e cor|er|s ol ry app||ca||or are |rue ard
correc|
AusAl0 |as ||e r|g|| |o vary or reverse ary dec|s|or regard|rg ar Aus|ra||a AWards 3c|o|ars||ps rade or ||e
oas|s ol |rcorrec| or |rcorp|e|e |rlorra||or
0ec|s|ors ol ||e se|ec||or pare| are l|ra| ard corl|der||a| ard ro corresporderce aoou| ou|cores ol ||e
se|ec||or process W||| oe er|ered |r|o.
+"reement
ll successlu| |r ga|r|rg ar Aus|ra||a 3c|o|ars||ps, l agree ||a| l W|||.
urdergo a po||ce or c|arac|er c|ec| oelore ry Aus|ra||a AWards 3c|o|ars||ps |s corl|rred
|rred|a|e|y prov|de AusAl0 W||| de|a||s ol ary |rc|der| ||a| ray rel|ec| oad|y or ||e pres||ge ol ar Aus|ra||a
AWards 3c|o|ars||ps
ac| |r a rarrer oel||||rg a rec|p|er| ol ar Aus|ra||a AWards 3c|o|ars||ps
use ||e lurds lor ||e purposes grar|ed
ac|roW|edge ||e ass|s|arce g|ver oy ||e Aus|ra||ar 0overrrer| |r ary Wr|||er repor|s, puo||ca||ors or puo||c||y
assoc|a|ed W||| ||e 3c|o|ars||ps.
Declaration and ac(no2led"ement
l dec|are, |r suor||||rg |||s app||ca||or lorr, ||a| ||e |rlorra||or cor|a|red |r || ard prov|ded |r correc||or W||| || |s |rue
ard correc|.
5 ac(no2led"e t%at "i#in" $alse or misleadin" in$ormation is a serious o$$ence under t%e Criminal Code Act 1995
o$ t%e Common2ealt% o$ +ustralia.
lu|| Nare 3|gra|ure 0a|e
Al0llA blZKl lAuZA
13 | 7| <?3@
25. !inistry o$ State Secretariat o$ t%e epublic o$ 5ndonesia use only
29
/ndorsement by t%e >o#ernment o$ 5ndonesia
( To oe corp|e|ed oy lead, 8ureau ol Tec|r|ca| Coopera||or, ||r|s|ry ol 3|a|e 3ecre|ar|a| ol ||e bepuo||c ol lrdores|a )
0r oe|a|l ol ||e 0overrrer| ol lrdores|a, l cer||ly ||a| l |ave exar|red ||e docurer|s a||ac|ed |o |||s lorr ard ar
sa||sl|ed ||a| ||ey are au||er||c ard re|a|e |o ||e app||car|.
l cer||ly ||a| ||e rax|rur |eve| ol s|udy, l|e|d ol s|udy ard |erg|| ol aWard proposed |r |||s app||ca||or are appropr|a|e
ard |r accordarce W||| ||e 0overrrer|'s |ra|r|rg po||cy.
l erdorse ||e app||car| lor ar Aus|ra||a AWards 3c|o|ars||p.
Nare ol cer||ly|rg oll|cer
T|||e
0rgar|sa||or
0ll|c|a| 3|arp 3|gra|ure 0a|e
| |
30