EOI Form

Contact Details

First Name *

Last Name *

Email Address *

Staff Username

Employment Details

Faculty

School / Department / Organisational unit *

Which of these best describes your current position

How long have you been employed at The University of Melbourne

Please use this space below to add any other details or contextual information about your role or responsibilities at the University.

Acknowledgement

I understand that this form is an expression of interest only, and that my eligibility for this course will be assessed based on my responses above.

I understand that, if enrolled in this program, successful completion requires attendance for the full duration of the session.

Privacy Collection Notice: The information in this form is being collected by the Melbourne CSHE. 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. For further information please read our full Privacy Collection Notice.