Privacy Collection Notice: The information on this form is being collected by the Melbourne CSHE or LH Martin Institute. You can contact us on +61 3 8344 4605 or melbourne-cshe@unimelb.edu.au for the Melbourne CSHE, or +61 3 8344 0756 or martin-institute@unimelb.edu.au for the LH Martin Institute. The information is being collected in order to complete your registration in our professional development program or record your attendance in our event. The information will be used by authorised staff for the purpose for which it was collected and will be protected against unauthorised access and use. Your information may also be passed on to your institution, employer or sponsor for their staff development or sponsorship program reporting purposes. If you do not provide all the information that is requested on this form it may not be possible for us to book a suitable venue, provide special requirements such as dietary and access or prepare materials prior to the commencement of your program or event. You may access any personal information you have provided to the University by contacting 13 63 52. The University of Melbourne is committed to protecting personal information provided by you in accordance with the Privacy and Data Protection Act 2014 (Vic). All information collected by the University is governed by the University’s Privacy Policy. For further information about how the University deals with personal information, please refer to the University’s Privacy Policy or contact the University’s Privacy Officer at privacy-officer@unimelb.edu.au.
Data Source
Organisation
Parent Campaign
Participant Type
Participant
Presenter
Free place
Expression of interest
Staffing
Position Contact Lookup
Position Org Lookup
Position Title
Primary Position
Registration Contact Lookup
Registration Position Lookup
Status
Completed
Withdrew
Deferred
Registered
Title
*
First name
*
Last name
*
Preferred name
Faculty/Division
*
Please select
Melbourne School of Engineering
Chancellery
Faculty of Architecture, Building & Planning
Faculty of Arts
Faculty of Business and Economics
Faculty of Medicine, Dentistry and Health Sciences
Faculty of Science
Faculty of Fine Arts and Music
Faculty of Veterinary and Agricultural Sciences
Melbourne Graduate School of Education
Melbourne Law School
University Services
Other
Other
*
Student ID
Student username (e.g. jsmith)
Degree Type
Please select
Masters by Research
Master of Philosophy
PhD
Other Doctorate
Other
Other
*
Candidature stage
Please select
First year
Second year
Third year
Fourth or more year
Preferred email address
*
Contact phone number
Dietary requirements (for catered programs only)
Special requirements (e.g. venue accessibility)
How did you hear about the program/event?
*
Please select
Other
Staff News
Faculty/School communication/newsletter
Supervisor
HR contact
Colleague
Recommendation from past participant
Melb CSHE or LH Martin Institute website
Melb CSHE or LH Martin Institute email or newsletter
Melb CSHE or LH Martin Institute social media
Other
*
Subscribe me to your newsletters
Choose item(s) of interest
*
Please select
Research
Teaching and Learning
Engagement
Leadership and management