Register your interest for LGBTIQA+ programs

We collect only information from you that we believe is needed:
(a) to provide you with the services you have requested;
(b) to maintain contact with you for service-related purposes; and
(c) to prevent harm (e.g., emergency contact).

If you have any difficulty completing this form, please contact Health, Wellbeing and Inclusion reception on (03) 9479 2956.


Please note: This portal is for non-urgent requests only.

If you are experiencing suicidal thoughts or if you are in an emergency situation, please contact the La Trobe University Crisis Line by calling 1300 146 307 or by texting 0488 884 100. Alternatively, you can contact Lifeline 24 hours a day, 7 days a week on 13 11 14.

Remember: If there is risk of imminent harm to you or someone else, call Emergency Services on 000.


Personal details
Note: This is the name the Counselling Service will use when contacting you. It does not need to match university records. You can update this at any time.
Please include full name as it appears on university records
Note: the Counselling Service will use these pronouns when contacting you. It does not need to match university records. You can update this at any time
Is it ok to leave a message at the number provided above?
Emergency contact details
e.g. what name and pronouns you would like used if emergency contacts are contacted
Validation

 

Confidentiality

La Trobe University respects the privacy of your information and is bound by various privacy legislation including the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic). La Trobe’s Health, Wellbeing and Inclusion division collects your information in order to provide you with our services and assistance. When you see one of our team, we are required to maintain notes (e.g of sessions, treatment and/or intervention plans). The teams within the Health Wellbeing and Inclusion division work collaboratively as a one service, to provide you with the best possible service and support. What this means is that your personal information may be used by different parts of the Health, Wellbeing and Inclusion as part of providing you with our services. We will, however, only disclose your personal information outside of the Health, Wellbeing and Inclusion division with your consent or as permitted by law.
You have a right not to disclose personal information to us. However, if you do not your provide your personal information then we may not be able to assist you.
You also have the right to access the personal information we hold about you (subject to any applicable legal exemptions), by contacting us at wellbeing.checkin@latrobe.edu.au (Students) or staff.wellbeing@latrobe.edu.au (Staff)
Please read our full privacy statement.