Biomedical Science (Medical) Rurality form

Understanding
I have read and understood * I have read and understood the acceptable rural residing evidence that must be submitted.
I understand * Residing refers to where you physically live. If you reside on campus, this will be considered. However, if the campus is not in a rural area, it cannot be claimed as rural residing. Only the location where you physically live will be considered for rural residing status, regardless of where your family or primary residence is. We will only recognise rural locations where you physically reside.
I understand * Applicants who submit fraudulent documents, attempt to gain an unfair advantage, or engage in misconduct during the application process may face a ban on future applications if their actions are deemed fraudulent. Consequences in such cases may include the cancellation of an application, withdrawal of an admission offer, or cancellation of enrolment

1. My details
Date of birth *
(NOT school email)

2. Rurality evidence
Consecutive means ‘following one after another without interruption.’
Please ensure you claim and provide evidence for rural locations where you have physically resided for five consecutive years or ten cumulative years.
Time period #1
Date claim commencing *
Date claim concluding *
Evidence type * Evidence being attached (select all that apply). Example of acceptable evidence.
Click (+) to upload another file. (jpg, pdf or png file type ONLY. Max 8MB file size)

Time period #2
Date claim commencing
Date claim concluding
Evidence type Evidence being attached (select all that apply). Example of acceptable evidence.
Click (+) to upload another file. (jpg, pdf or png file type ONLY. Max 8MB file size)

Time period #3
Date claim commencing
Date claim concluding
Evidence type Evidence being attached (select all that apply). Example of acceptable evidence.
Click (+) to upload another file. (jpg, pdf or png file type ONLY. Max 8MB file size)

3. Rurality statements

Please provide TWO statements to show your commitment to community. Each statement is limited to 700 characters.

If you are invited to an interview, your statements will be used to inform the interview questions. De-identified responses may also be used for research and evaluation to improve selection into medicine.

Statement #1
NOTE: A community may be defined by a place, or by its people. Please include your regional and/or rural community (Max 700 characters)

 

Statement #2
(Max 700 characters)

4. Academic transcript
Applicant type *
  • Current Year 12 – attach year 11 results
  • Non year 12 with tertiary study – attach academic transcript
  • Non year 12 – attach year 12 results / ATAR

If the personal details you provided above are different to your academic transcripts, please attach proof of change of personal details eg change of name.

Click (+) to upload another file. (jpg, pdf or png file type ONLY. Max 8MB file size)


Declaration
  • I have attached acceptable documentation that supports living rurally for 5 years consecutively or 10 years cumulatively.
  • I have completed the personal statement(s).
  • To the best of my knowledge, the information given in this application is correct and complete.
  • I understand that submitting false or misleading information may result in any offer of a place withdrawn at any stage, including after a course has commenced.
  • I understand the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information.
  • The University is under no obligation to consider any application submitted after the due date.
  • I authorise La Trobe University to seek and obtain official records pertaining to me from any educational authority holding such records either directly or via electronic request.
  • I acknowledge and accept the full enrolment terms and conditions that govern this application form.


Privacy

La Trobe University respects the privacy of your personal information and your privacy is important to us. Information collected on this form will only be used by the University for the purposes related to assessing your application and in accordance with the Website Privacy Statement and the University's Privacy Policies. 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 03 9479 1839.

Validation