Students > Careers and Opportunities > Work Integrated Learning and Placements > Placements and WIL > Health placements > Social Work Student Placement forms > Non-standard placement application

Non-standard placement application

Required fields are marked with an asterisk (*).

Student details

Given name *

Family name *

Student number *

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

Phone *

Campus *

Placement details

This is my *

Previous placement

Type of placement

Name of host organisation

Field of practice

Did you have on-site Social Work supervision?

Did you have an External Field Educator?

Placement typeI am applying for *

State *

Reason *

Supporting document (.pdf or .jpg file type only. MAX 8MB file size.)

Location *

Reason *

Supporting document (.pdf or .jpg file type only. MAX 8MB file size.)

Please specify your preference for number of placement days per week *

3 days
4 days

Reasons for request *

Please upload a copy of an appropriate Medical Certificate(PDF or JPG file types only. Max 8 MB file size) *

Validation

Privacy statement

La Trobe University respects the privacy of your personal information. We, the College of Science, Health and Engineering Placement Operations, collect personal information about you to consider your request for a non-standard placement. For this purpose, we will use this information and typically disclose it to Placement Providers you may be allocated to. If your personal information is not provided to us then your application for a non-standard placement will not be considered. You may have the right to access the personal information we hold about you subject to any exemptions in relevant laws, by contacting Josh Apeltauer, Senior Coordinator Placement Operations on 9479 5726 or j.apeltauer@latrobe.edu.au