Faculty of Health Sciences School of Nursing and Midwifery Single Subject Application Package (fee paying place) Semester 2, 2011 (mid-year) CLOSING DATE: FRIDAY 10 JUNE 2011 This package includes the following: Study information 2011 Sem 2 Single Subject Supplementary Application Form: Sections 1 and 2 Supplementary Application Checklist La Trobe University Application Form Please note: Complete this form only for single subject enrolments (fee paying place). Applicants are asked to read all information prior to completing the forms. Applications may be returned without consideration if forms are not completed correctly. Applicants will receive an email notification confirming receipt of their application. Consideration of timely applications will be completed by mid-july: Successful applicants will receive an offer letter and enrolment documents for completion. Unsuccessful applicants will receive a notification letter. Further information is available via the La Trobe University website: http://www.latrobe.edu.au/nursing/prospectivestudents Alternatively please email: health@latrobe.edu.au Page 1 of 7
Study Information I want to undertake a Graduate Certificate, Postgraduate Diploma or a Masters program This is the Single Subject Application Form - ONLY COMPLETE IF YOU INTEND TO ENROL FOR A SINGLE SUBJECT ENROLMENT. IF YOU INTEND TO APPLY FOR A COURSE ENROLMENT please visit the La Trobe University website and download the Semester 2 (mid-year) application form from the Nursing and Midwifery Postgraduate page http://www.latrobe.edu.au/nursing/prospectivestudents/postgraduate2009/index.php. I want to undertake the Nurse Immuniser Program To apply for this program please follow the prompts through the following weblink: http://www.latrobe.edu.au/nursing/prospectivestudents/continuingeducation/nurseimmunisation.php All enquiries regarding this program should be directed to: Program Administrator, Nurse Immuniser Program Phone: 03 9479 5951 Fax: 03 9479 5988 Email: nip@latrobe.edu.au Clinical Placements What if I don t get a clinical placement and I need one? If you are undertaking a subject which requires clinical placement, it is your responsibility to ensure that you obtain a clinical place. If you failed to obtain a clinical place, it is your responsibility to withdraw from the subject prior to the first census date to ensure that you are not charged for your enrolment. How do I find the specific clinical requirements of each subject? Please visit this website and click on the subject you are interested in undertaking. http://www.latrobe.edu.au/udb_public/publicview$.startup Any text that is underlined is hyperlink to further information. Please note that a subject is also referred to as a Unit in some instances. Certified copies All photocopies of original documentation (Nursing registration, Academic Transcripts, Marriage Certificates etc) must be signed and dated by a suitably qualified person (eg: Justice of the Peace, Pharmacist, Member of the Police Force, CPA, Medical Doctor). All applications will be considered on Academic Merit. Certified copies required: 1. Formal qualifications, including copies of academic records (transcripts); 2. Professional development activities, including copies of certificates of attainment. Page 2 of 7
Closing Dates The closing date for applications is FRIDAY 10 June 2011. What do I have to do to obtain a CSP? No CSP places are being offered for single subjects How do I find out the cost for single subject enrolments? Visit http://www.latrobe.edu.au/students/fees/course/single-subject to calculate single subject fees. Address for Mailing 2011 applications Where is the Supplementary Form? Pages 4-5 of this document are the Supplementary Form. Level of detail needed Jeanette Wilkins Postgraduate Student Services Officer Re: Application for Sem 2 Single Subject Enrolment Faculty of Health Sciences La Trobe University MELBOURNE (BUNDOORA) VIC 3086 Please complete all areas on both forms. For example, you must complete your name on the Supplementary Form and on the La Trobe University Application Form. Please BLOCK PRINT your name, address and private email address. This will help prevent enrolment errors. It will also ensure that you receive all relevant documentation in a timely manner. I would like to know more about the subjects? After reading the subject descriptions from the Unit Database, please contact the relevant subject coordinator (contact details on the next page): More questions? This link gives you access to more information http://www.latrobe.edu.au/nursing/prospectivestudents/postgraduate2009/index.php CONTACT US FOR : ALL Single Subject Enrolment enquiries: Jeanette Wilkins Postgraduate Student Services Officer Email: j.wilkins@latrobe.edu.au Phone: (03) 9479 5610 ALL Coursework Enrolment Enquiries: Phone: (03) 9479 5815 Email: health@latrobe.edu.au Web: www.latrobe.edu.au/nursing Page 3 of 7
Faculty of Health Sciences School of Nursing and Midwifery 2011 Sem 2 Single Subject Supplementary Application Form TIMELY CLOSING DATE FRIDAY 10 June 2011 Section 1 Title (Miss, Ms, Mrs, Mr, Dr, etc) Phone Number Family Name Given Names Email Address To receive University correspondence print in BLOCK LETTERS Postal Address (Street, Suburb, State & Postcode) Nursing Registration Number State of Registration Study Load Single Subject Application Tick to select Location Subject Code Course Title Subject Coordinator Contact details Distance NSG4BCF Breast Care Nursing: Foundations for Practice Mrs Liz Pascoe e.pascoe@latrobe.edu.au 03-9496 4465 Distance NSG5CAU Clinical Audit # Dr Les Fitzgerald l.fitzgerald@latrobe.edu.au 03 5444 7856 Distance NSG4NLC Nursing People with Lung Cancer Mrs Liz Pascoe e.pascoe@latrobe.edu.au 03-9496 4465 Distance NSG4SCN Special Care of the Neonate* Ms Melissah Burnett m.burnett@latrobe.edu.au 03 9479 5914 Distance NSG5CPD Clinical Practice Development Dr Maria Murphy m.murphy@latrobe.edu.au 03-9496 2671 Distance NSG5RPA Research Processes A Dr Eileen Petrie Distance NSG5RPB Research Processes B Dr Eileen Petrie Distance NSG5CHE Clinical Education B* Ms Monica Peddle e.petrie@latrobe.edu.au 02-6024 9719 e.petrie@latrobe.edu.au 02-6024 9719 m.peddle@latrobe.edu.au 03-9479 5903 Distance NSG5CHA Comprehensive Health Assessment Ms Pauline Wong p.wong@latrobe.edu.au 03-9479 6734 Distance NSG4NPC Prostate Cancer Elizabeth Watt e.watt@latrobe.edu.au 03-9496 4461 *Access to clinical placement is required # Access to clinical data is required Page 4 of 7
Section 2 Clinical Placement Details (if applicable) If your course involves a Clinical Placement please indicate the hospital / facility at which you intend completing the clinical component of the course: Hospital: Address: Clinical educators Name Telephone: If relevant, have you applied separately for your clinical placement with the above listed hospital: Yes or No (circle) If yes, please indicate when you expect to hear the outcome of your application: If employment is required at a Hospital, please contact the Hospital directly to submit a separate application. ALL applications must be returned directly to: Jeanette Wilkins Postgraduate Student Services Officer Re: Application for Sem 2 Single Subject Enrolment Faculty of Health Sciences La Trobe University MELBOURNE (BUNDOORA) VIC 3086 HOW DID YOU FIND OUT ABOUT OUR SINGLE SUBJECTS? Newspaper Nursing Expo University Open Day Word of Mouth Internet Other (please specify): Page 5 of 7
Supplementary Application Checklist Please ensure you have provided the following documentation. Applications may be returned without consideration if you have not completed all necessary sections. Have you read the study Information on pages 1-3 of this document? Have you included certified copies of your Academic Transcript/s? Have you included certified copies of your Current Registration with the Nurses Board of Victoria? Have you clearly indicated your Subject Selection on page 4? Have you included a certified copy of your Evidence of Change of Name (if applicable)? Have you included Evidence of Citizenship or Permanent Residency? Have you completed, signed and dated the University Application Form attached after page 7 Have you completed, signed and dated the Supplementary Information Form pages 4 and 5 Page 6 of 7
LA TROBE UNIVERSITY SINGLE SUBJECT APPLICATION FORM Please ensure the following three (3) pages are completed in full. Applications may be returned without consideration if you have not completed all necessary sections. Page 7 of 7
Academic Services Application for Single Unit Enrolment Single Unit Enrolment: This form is to be completed by a student who wishes to study a subject at La Trobe University. Single unit enrolment is only offered on a fee-paying basis to eligible domestic and international students. Single unit enrolments do not lead to an award but credit may be granted towards an award. Please refer to the University handbook webpage for details regarding available subjects: www.latrobe.edu.au/handbook Personal Details Have you previously been enrolled at La Trobe University? Yes* No *If yes, please provide your La Trobe student number: Title Mr Mrs Ms Miss Dr Other: First Name/s Date of Birth D D M M Y Y Family Name Address Suburb/City State Postcode Country (if not Australia) Telephone Number Email Address International Students Are you an international student? Yes* No Are you a U.S. Financial Aid or Sponsored Student? Yes* No *If you hold a student visa you must complete within the time your Electronic Confirmation of Enrolment to meet visa requirements. Subjects listed on this form are not credited to an award course. DO NOT use this form if you require the subject you are enrolling in to be credited to the registered course for which you currently hold a student visa. Use a Variation of Enrolment form or seek further advice from your faculty or LTI. Proposed Subjects Date LTI Approval (staff signature) LTI Stamp Subject Code Subject Title Location Teaching Fees* Period LTU Approval (Head of School) * Fees: Applicants are liable for payment of tuition fees to La Trobe University. Students are NOT eligible for HECS-HELP or FEE-HELP for single subject/s of study enrolment. Previous Studies Attempted Last Yr Award Relevant Subject/s Institution Attempted Completed Yes / No Yes / No Yes / No Faculty Approval (official use only) All applications MUST be signed and dated by a staff member. Applications WILL NOT be accepted without this information. Name Signature Course Code SIS ID Number Date PAGE 1 OF 3
Statistical Data Are you of Australian Aboriginal descent? Yes No Are you of Torres Strait Islander descent? Yes No Please select the citizenship/residency status that applies to you: Australian citizen New Zealand citizen Permanent Humanitarian Visa (please attach a certified copy of your visa) Permanent Resident Status. Other (please specify): Date you obtained Permanent Resident Status: D D M M Y Y Residence: Permanent home residence postcode: Semester residence postcode: If born overseas, indicate year of arrival in Australia: Year completed Year 12: If residence is overseas, state country: Language spoken at permanent residence: Country of Birth: If Year 12 residence was overseas, state country: Year 12 residence suburb postcode: What is your highest level of educational participation prior to commencement of this course? (please select one) 02 Completed Higher Education postgraduate level course completion year: 03 Completed Higher Education Bachelor level course completion year: 04 Completed Higher Education sub-degree level course completion year: 05 Have started but not completed Higher Education course last year of participation: 07 Completed final year of secondary education course at school or TAFE completion year: 08 Completed other qualification or certificate of attainment or competence complete or incomplete completion year: 09 No prior educational attainment 10 Completed Vocational & Technical Education course (e.g. TAFE) completion year: 11 Have started but not completed a Vocational & Technical Education course (e.g. TAFE) last year of participation: Please provide the highest level of educational attainment for your parent (s) guardian (s). Parent/Guardian 1: Gender: Male Female Unknown Postgraduate qualification (e.g. Postgraduate Diploma, Masters, PhD) Bachelor Degree Other post school qualification (e.g. VET Certificate, Associate Degree, Diploma) Completed Year 12 schooling or equivalent Did not complete Year 12 schooling or equivalent Completed Year 10 schooling or equivalent Did not complete Year 10 schooling or equivalent Parent/Guardian 2: Gender: Male Female Unknown Postgraduate qualification (e.g. Postgraduate Diploma, Masters, PhD) Bachelor Degree Other post school qualification (e.g. VET Certificate, Associate Degree, Diploma) Completed Year 12 schooling or equivalent Did not complete Year 12 schooling or equivalent Completed Year 10 schooling or equivalent Did not complete Year 10 schooling or equivalent Accessibility Requirements: Do you have a disability, impairment or long term medical condition? Yes* No *If yes, would you like to receive advice on support services? Yes No *If yes, the disability or medical condition is described as: Hearing Learning Medical Mobility Vision Other: PAGE 2 OF 3
Declaration and Agreement DOMESTIC STUDENTS ONLY I declare that the information provided on this form is true and complete in every detail. I authorise La Trobe University to contact my former educational institutions in order to verify any of the information I have provided with this application, if deemed necessary. I understand the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information provided by me. Signature: Date: / / INTERNATIONAL STUDENTS ONLY I declare that the information provided with this application is true and complete in every detail. I authorise La Trobe University or its agent to obtain further information about me from educational and other institutions which I have attended, and from Australian government authorities such as DIAC and DEEWR. I acknowledge that La Trobe University reserves the right at any stage to vary or reverse any decision regarding admission or enrolment which has been made on the basis of incorrect or incomplete information. I am aware of the conditions relating to my admission and agree to pay all fees for which I am liable, and have read and agree to the conditions relating to the Refund Policy and Privacy Statement as set out on the University s website at http://www.latrobe.edu.au/international/fees/tuition. This agreement does not remove my right to take further action under Australia s consumer protection laws. I consent to the University: (a) Using and disclosing my personal information in accordance with the University s Refund Policy and Privacy Statement; and (b) Disclosing my personal information to a third party, authorised by the University, to enable the third party to contact me for the purposes of providing me with information about the University. I accept that this application and supporting documentation become the property of La Trobe University and are not returnable. Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth). Signature: Date: / / Contact Details Albury-Wodonga Campus Bendigo Campus Bundoora Campus Student Administration Office Student Administration Office Student Administration Office La Trobe University La Trobe University La Trobe University PO Box 821 PO Box 199 Victoria 3086 Wodonga Vic 3689 Bendigo Vic 3552 Mildura Campus Student Administration Office La Trobe University PO Box 4095 Mildura Vic 3502 Shepparton Campus Student Administration Office La Trobe University PO Box 6044 Shepparton Vic 3632 Academic Services January 2010 Version 3.0 CRICOS provider number: 00115M PAGE 3 OF 3