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

Rural Health Placement Travel Grant Application

Personal details

Student number *

Title

Given name *

Family name *

Street address *

City *

Postcode *

Contact number *

Student Email address *

Personal Email address *

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 a 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 development? *

Accommodation details

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

Expenditure

Accommodation ($) *

Travel ($) *

Please ensure that you have combined all relevant receipts into a singular document before attaching it to your application.
You can do this by placing the scans of your receipts into a singular Microsoft Word document or combining them into a singular PDF.

Receipt * (doc, docx, 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? *

The Australian Government requires us to track La Trobe Rural Health School graduates for up to 5 years to identify the impact on the rural and regional workforce. If successful, do you agree to submit the required survey of longitudinal tracking for up to 5 years after you complete your studies? *

Validation

Confidentiality

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 UDRH team via email at udrh@latrobe.edu.au The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/