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Personal Details

Given name *

Middle name

Family name *

Gender *

Date of birth *

Day Month Year

Are you an Australian citizen/Permanent resident *

If No please specify your citizenship

Student number *

Passport number *

Residential address *

Postal address * (if same as residential address, please indicate “As above”)

Telephone

Mobile phone *

Email address *

Current studies

Title of degree or major *

College *

Campus *

Degree commencement date *

Month Year

Expected completion date *

Month Year

Other tertiary education history (if any)

Title of degree [1]

Awarding institution [1]

Period of study [1]

Title of degree [2]

Awarding institution [2]

Period of study [2]

Your participation

Please state the reasons why you want to participate in this program. What do you expect to achieve from this program? *

What would you be able to contribute to this program if you are being selected? *

Briefly outline and explain issues/topics within the framework of the sub-themes that you would like to discuss if selected to participate in the 2018 ACSF *

Please attach your Curriculum Vitae * (.doc, .docx, .pdf, .rtf, .txt file types only. 8MB max size)

Please attach proof of your citizenship or residency * (.jpg, .pdf, .png file types only. 8MB max size)

Other information

Please indicate from which source you learnt about this program

If selected, do you agree for your images to be used in future promotional materials for this program?

Declaration

Declaration *

I declare that all information provided on this form is true and complete in every detail

Privacy

La Trobe University respects the privacy of your personal information. We, the Confucius Institute at La Trobe University, collect personal information about you for the ACSF 2016 program application process and selection panel. For this purpose, we will use this information and typically disclose it to only the employees of the Confucius Institute involved in the ACSF 2016 program. If your personal information is not provided to us then you will not be able to apply for the ACSF 2016 program. You may have the right to access the personal information we hold about you subject to any exemptions in relevant laws, by contacting us on confuciusinstitute@latrobe.edu.au

If you have any queries about this program, please call (03) 9479 6504 or email confuciusinstitute@latrobe.edu.au