La Trobe University > Events > Event registration forms > The Holsworth Biomedical Research Initiative Summer School Registration Form

The Holsworth Biomedical Research Initiative Summer School Registration Form

Personal information

Given name *

Family name *

Date of birth *

Day Month Year

Current street address *

Suburb / city / town *

Postcode *

Phone *

Personal email address * (Not your school email address)

Have you been fully vaccinated against COVID-19? * (Note: You may be requested to provide evidence of vaccination)

Parents or guardians name *

Parents or guardians contact number *

Parents or guardians email *

School information

School name *

Year level *

Subjects undertaking in 2022 *

School reference

Name of teacher *

Teacher's email *

Teacher's contact number *

Statements

What makes you passionate about biomedical and/or health science? * Maximum of 200 words or 700 characters

What are your aspirations for your future in biomedical and health sciences? * Maximum of 200 words or 700 characters

Declaration

• I have completed the personal statement(s).
• To the best of my knowledge, the information given in this application is correct and complete.
• I understand that submitting false or misleading information may result in an offer of a place withdrawn at any stage.
• I understand the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information.
• The University is under no obligation to consider any application submitted after the due date of 5 pm AEDT Friday 28 October 2022.
• I authorise La Trobe University to seek and obtain a referee check about me from any educational authority holding such records either directly or via electronic request.
• I am available to travel to the Bendigo La Trobe University campus between Monday 12 and Wednesday 14 December 2022.

Have you read and agree to the declaration above? *

I have read and agree to the declaration above

Validation

Confidentiality

All information provided will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information for the purposes of your application. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting La Trobe University via email at studyregional@latrobe.edu.au
The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/