Industry Placement Application Form Please note: This form is for Student Sourced applications ONLY, for the following subjects:LTU2001LTU2002LTU2003LTU3INDLTU5INDLTU2PP1LTU2PP2LTU3PP3LTU3PP4Before submitting your application for an Industry Placement, you MUST enrol into your preferred subject. It's also important to review key dates, eligibility, and ensure you have free elective space. Find out more about how to apply. Student details Student name * Student ID * Email address * (this must be your La Trobe student email address, e.g. j3smith@students.latrobe.edu.au) Phone * Course * Campus -- Please Select --Albury-WodongaBendigoChisholm InstituteMelbourne (Bundoora)Melbourne (City)MilduraSheppartonSydneyOnline Student Type? * Undergraduate Postgraduate Are you an international student? * Yes No Do you have a Learning Access Plan (LAP) or other special considerations which may impact on your ability to fully participate on placement? * We encourage students to disclose their LAP as part of their application, particularly where it may impact on their ability to fully participate on placement. The reason for this is to allow time for you to consider the value of disclosure to supporting your learning on placement. It may be particularly important to disclose your disability to your supervisor so that they can best support any necessary accommodations in the workplace either immediately or potentially in the future depending on the nature of your disability. If you are not sure about doing so, please take the time to speak with your Accessibility Advisor or Subject Coordinator. -- Please Select --YesNoI'd prefer not to say Which subject have you enrolled in? * LTU2001, LTU2002, LTU2003, LTU3IND, LTU5IND One or more of the Professional Placement Subjects (LTU2PP1, LTU2PP2, LTU3PP3, LTU3PP4) Have you checked your study plan and/or discussed with ASK La Trobe/Course Coordinator to confirm you have the space to undertake this elective subject? Yes No Indicate the semester for which you are applying to undertake your placement Semester 1 Semester 2 Summer Have you discussed your interest in completing the Professional Placement subjects with the program coordinator? See application instructions on the How to Apply page. Yes No Select the subjects that you would like to complete. LTU2PP1 (100 hours) LTU2PP2 (100 hours) LTU3PP3 (100 hours) LTU3PP4 (100 hours) Select the subjects that you would like to complete. LTU2PP1 (100 hours) LTU2PP2 (100 hours) LTU3PP3 (100 hours) LTU3PP4 (100 hours) Name of Host Organisation: * Address of Host Organisation: Key Contact/Supervisor: * Key Contact/Supervisor Phone: Key Contact/Supervisor Email: * Estimated Start Date: Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Estimated End Date: Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Estimated total placement hours: * Upload your Student Sourced Placement Description * * Max 8mb file size Upload your academic transcript * Download your unofficial academic transcript for free. (Pdf file type only. Max 8mb file size) Consent I am indicating my consent for La Trobe University to provide my CV, resume and student transcript to the host below. I understand that the data collected from my participation will be used primarily for this application, and I consent for it to be used in that manner. I do not consent to La Trobe University to provide my CV, resume and student transcript to the above host. Additional information Important information La Trobe University may share application documentation including CV, student transcript and application information. The data collected from this application will be used to assess suitability for placement. Placements may be cancelled or postponed due to unforeseen circumstances, which may affect study plan or course progression. The university cannot guarantee that placement applications will be accepted or that alternative placement arrangements can be provided. Privacy 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 in your application to determine your eligibility for a scholarship, bursary or grant, and to assess your application as part of the ranking and allocation process. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose or disclosed to any person who is not part of the La Trobe assessment and allocation process, 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 the Scholarships Office. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy. I confirm that all the information provided in this application is complete and correct. * I confirm Validation