Students > Careers and Opportunities > Work Integrated Learning and Placements > Placements and WIL > Health placements > Grants and scholarships > Health Placements Travel Grant Application

Health Placements Travel Grant Application

Required fields are marked with an asterisk (*).

Personal details

Student number *

Title

Given name *

Middle name

Family name *

Street address *

Suburb/Town *

State

Postcode *

Phone number *

Student email address * (e.g. j1234@students.latrobe.edu.au)

Bank details

Account name *

BSB number * (6 digits)

Account number *

Bank name *

Enrolment details

Course of enrolment *

Campus

Subject code *

Subject name *

Placement details

Name of Organisation *

Street address *

Suburb/City/Town *

Postcode *

State *

Start date *

Day Month Year

End date *

Day Month Year

How many days each week were you on placement? *

How many hours each day were you on placement? *

What is the distance (in kms) from your place of residence to the address at which you undertook your professional placement? *

Accommodation details

Did you live away from your usual semester residence to participate in the placement? *

Where did you stay whilst on placement?

with family/relatives/partner/friends
in rented accommodation

Please provide the full name, address and a copy of the receipt for your accommodation.

Name *

Address *

Expenditure

Accommodation ($)

Travel ($)

Receipt #1

Upload file #1 * (.pdf, .jpg or .png file type only. Max 8MB file size)

Add another receipt

Receipt #2

Upload file #2 (.pdf, .jpg or .png file type only. Max 8MB file size)

Add another receipt

Receipt #3

Upload file #3 (.pdf, .jpg or .png file type only. Max 8MB file size)

Add another receipt

Receipt #4

Upload file #4 (.pdf, .jpg or .png file type only. Max 8MB file size)

Additional information

Please add any additional information relating to your financial situation or the impact of the placement that you believe should be considered in this application

Have you previously received a grant which is designed specifically to support you while on placement? *

Which grant did you receive? *
(e.g. Employability Grant, Mobility Grant)

When did you receive it? *
Year

Privacy statement

La Trobe University respects the privacy of your personal information. The College of Science, Health and Engineering collects personal information about you for the purpose of assessing your eligibility for the travel grant and we will only use this information for this purpose. If your personal information is not provided to us your application will be incomplete and you will be deemed ineligible. 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 Travelgrant.placements@latrobe.edu.au or 03 9479 5726.

Validation