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Further Enquiries:
Frome Road
Level 5, Medical School North Bldg
THE UNIVERSITY OF ADELAIDE
ADELAIDE SA 5005
AUSTRALIA
Email

Telephone: +61 8 8303 5571
Facsimilie: +61 8 8224 0685

Application for Admission

International Programme in Addiction Studies
Master of Science in Addiction Studies

To apply for the Master of Science in Addiction Studies, please submit this form online and return the completed, signed application via mail, along with three sealed letters of reference, your curriculum vitae, and copies of academic transcripts in a single envelope to:

Prof. Jason White
Discipline of Pharmacology
Level 5, Medical School North
Frome Road
Adelaide SA 5005
Australia

As mentioned in the application instructions, you can also choose to send the information to Mary Loos or Kim Wolff because of the time restrains.

All mailed application documents must be received by 1 July 2010.

Online Application

Follow the instructions for each question carefully and complete all requested fields (denoted by an asterisk*).

Your details

Family name*		First name*		Middle name
Sex*	Male Female	Date of birth*	(dd/mm/yyyy)
Current Residential Address	Number: Street: City: State: Country: Postal Code:
Telephone number*	(include Country and area code)
Email address*
Postal Address (only if different to residential)	Number: Street: City: State: Country: Postal Code:

Place of birth*		Country of birth*
First language*		Social Security number	(US Applicants only)

Entry year

Preferred year of entry*

Standardised Testing

Note: only information on TOELF or IELTS scores are mandatory, and then only for students from a country where English is not the first language or who have not successfully completed a degree studied in the English language.

Test	Score	Date taken
TOEFL (Test of English as a Foreign Language)		(dd/mm/yyyy)
IELTS (INT English Language Testing Service)		(dd/mm/yyyy)
GRE (Graduate Record Examination-Aptitude)		(dd/mm/yyyy)
Other test (please identify)		(dd/mm/yyyy)

Educational background

Please fill in the details of at least one previous place of education as outlined in the application instructions.

	Name and location of Institution (city and country) Academic level	Dates of Attendance (from month/year to month/year completed)	Major field of study and Grade point average/grade point average scale (e.g, 3.2/4.0;8/10) or classification (pass, distinction) where applicable	Degree, certificate or diploma awarded and date awarded or to be awarded.
1.*
2.
3.
4.
5.
6.

Curriculum vitae

Please attach your curriculum vitae as a separate document including all items as outlined in the application instructions*:

Academic references

List the names, addresses and positions of three persons, preferably professors, supervisors, or professionals, who are completing reference forms for you. At least one reference must be from an institute of Higher Education.

First referee*
Name
Position
Address
Second referee*
Name
Position
Address
Third referee*
Name
Position
Address

Ethnic origin

Please tick one of the following options.
Note: providing information on ethnic background is not compulsory.

Aboriginal and/or Torres Strait Islander

African-American

Asian or Asian British

Other Asian Background

Bangladeshi

Black African

Black Caribbean

Other black background

Chinese

Hispanic or Latino

Indian

Other Indian background

Irish

Native Hawaiian or other Pacific Islander

Native American or Alaskan Native

Mixed (White and Black Caribbean)

Mixed (White and Black African)

Mixed (White and Asian)

Pakistani

Persian

White/Caucasian (British)

White/Caucasian (Irish)

White/Caucasian (other)

Other background not listed:

How did you first hear about our programme?*

What influenced you to apply?*

Personal statement

On a separate sheet, please write a personal statement in which you discuss the following:

your reasons for seeking to obtain this degree, including your career goals and how you envision that the programme will help you meet those goals
prior life/work experiences that relate to your interest in and aptitude for the programme, and
your perception or your capacity to complete the programme successfully.

Attach personal statement*:

Submit your application

Please ensure you've filled out all necessary form fields and uploaded all required documents (as denoted by an asterisk*) before you submit this form.

Or, you can reset the form and start again.