Expression of Interest Form - 2024

Contact details

Title

Name *

Surname *

University of Melbourne email address * Personal email address will not be accepted

Staff username please use lowercase only e.g. smithk (leave blank if unsure)

Staff ID Number This is found on your staff ID card and is usually 6 digits long

Employment details

Faculty *

School / Department / Organisational unit *

Current position *

Employment status *

Continuing
Fixed term contract
Sessional / Casual

Have you previously acted or are currently acting in a Supervisory role at the University of Melbourne? *

If yes, please advise timeframe and duties undertaken

Please provide your reasons for applying to undertake the Program

Please provide your reasons for applying to undertake the program. How will it benefit your role and school/organisation unit? *

If your application is successful, do you intend to complete the program for credit? That is, complete all assessment tasks for all four modules (quiz, metareflection and workshop attendance). Please note you can change your mind at any time during the program and this information is collected for planning purposes only.

Have you previously undertaken any part of the MALM Program? Please specify Modules completed and the cohort you were enrolled in. E.g. 2022 Alpha Module 1 complete, Module 2 started but not complete

Do you require any special considerations in order for you to undertake this program? E.g. Accessible classrooms, based on regional campus

Declaration

I declare that all relevant questions have been answered accurately and that I have obtained the necessary support of my supervisor to undertake the Program *

Supervisor's name *

Supervisor's email address

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

The information on this form is being collected by the Melbourne CSHE. The information is being collected for the legitimate interest of completing your registration in our professional development program. 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.