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Student Placement Form

Student Placement Application

eg. DD/MM/YYYY

Information about the University you are coming from

Information about your proposed placement

eg. DD/MM/YYYY

eg. DD/MM/YYYY

eg. DD/MM/YYYY

Please Note: These placement types refer to Grafton Medical Students only. i.e. You should only choose these options if your placement location is Grafton

Please Note: These placement types refer to Grafton Medical Students only. i.e. You should only choose these options if your placement location is Grafton

Please Note: These placement types refer to Grafton Students only. i.e. You should only choose these options if your placement location is Grafton

eg/ DD/MM/YYYY

eg. DD/MM/YYYY

eg. DD/MM/YYYY

Please specify any special requirements such as wheel chair access, health issues or any other needs that may be relevant to your placement

NSW Health Department requires students to have a current Criminal Record Clearance. If not already held, see your University Program Administrator for assistance.

Please upload a passport photo for your Hospital ID Card

Please Note:: Only Lismore students need attatch this

Please bring copies of your originals including full vaccination records and serology