Biomedical Science (Medical) Rurality form

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

2. Rurality evidence
Time period #1
Date claim commencing *
Date claim concluding *
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)

Time period #2
Date claim commencing
Date claim concluding
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)

Time period #3
Date claim commencing
Date claim concluding
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)
(jpg, pdf or png file type only. Max file size 8 MB)

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
Are you applying as a non-year 12 applicant with tertiary study? *

Upload a high-quality colour scan of your official academic transcript demonstrating 1 year effective full time study load for tertiary study.

Ensure that:

  • you are scanning original, official documents
  • your scans are high quality, clear, easy to read and in colour
  • your documents are scans and not photographs (you can use a scanner app on a phone)
  • the scans are not askew or poorly focused as these will be rejected
(jpg, gif, pdf or png file type ONLY. Max 8MB file size)
(jpg, gif, pdf or png file type ONLY. Max 8MB file size)
(jpg, gif, pdf or png file type ONLY. Max 8MB file size)

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

(jpg, gif, pdf or png file type ONLY. Max 8MB file size)
(jpg, gif, 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 of 5pm AEDT Friday 4 December 2020.
  • 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