International delegation request form This form is intended for requests from individuals and groups, to make a formal visit to La Trobe University on an institution-to-institution level. Please complete all sections and submit this form at least 30 days before the date of your proposed visit. This will enable us to organise a schedule that will meet your needs. Request details The person making this visit request is: * La Trobe University Staff External Please indicate the institution you represent Preferred date and time of visit * Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 20262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Hour 000102030405060708091011121314151617181920212223 Minute 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Is a letter of invitation required? * Yes No Do you require an interpreter? * Yes No Details of person making the request Title * -- Please Select --PresidentVice PresidentProfessorAssociate ProfessorMrMrsMs Given name * Family name * Position * Email address * Contact number Visiting institution Name of institution * Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoDemocratic Republic of the CongoCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoFormer Yugoslav Republic of MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaRepublic of MoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-Leste (East Timor)TogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamBritish Virgin IslandsU.S. Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe Institution address Website Please give an overview of your institution or organisation * e.g. current university ranking, current global and Australian partnerships, courses/units taught in English. Current University Rankings and Ratings, and key research interests/disciplines of visiting institution * Key purpose of visit * e.g. discussion of research collaboration, agreement discussion, mobility program, course development). Please indicate which La Trobe staff/ department/areas you would like to meet. You may wish to outline the topics/areas of discussion. Academic focus * -- Please Select --School of Agriculture, Biomedicine and EnvironmentSchool of Humanities and Social SciencesSchool of Allied Health, Human Services and SportLa Trobe Law SchoolLa Trobe Business SchoolSchool of Nursing and MidwiferySchool of Computing, Engineering and Mathematical ScienceSchool of Psychology and Public HealthSchool of EducationLa Trobe Rural Health SchoolOther Delegation details Organiser/key contact of the group Title * -- Please Select --PresidentVice PresidentProfessorAssociate ProfessorMrMrsMs Given name * Family name * Position * Email address * Contact number * Please include the area code if the contact number is outside Australia. Delegation members Please list the name and job title of each delegate visiting the University * Include birth date only if a letter of invitation is required. Previous contact with La Trobe University Has your institution had previous contact or collaboration with La Trobe? * Yes No Please provide details of any current agreements, initiatives, or collaborations e.g. MOU agreements, Staff/Student Exchange/Study tours/research/Staff names Additional information Would the delegation like a campus tour? * Yes No If yes, please indicate specific areas of interest Accommodation and travel details for the delegation while in Melbourne * e.g. flight details/hotel name Is there any additional information you would like to provide? Attach file The request will be considered upon receipt of this form. The Relationship Management team will be in contact to advise if the request can be accommodated. Validation Privacy Statement All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information to organise visits and, if required, prepare Letters of Invitation that list the institution representatives wishing to visit the University. In accordance with privacy laws, personal information about you contained in your enquiry will not be used for any other purpose or disclosed to any person who is not part of organising your visit without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting La Trobe's Educational Partnerships team via email at Edpartnerships.international@latrobe.edu.au. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/