CSGT Expression of Interest form

Required fields are marked with an asterisk (*).

Contact details

Given name *

Family name *

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

Staff username * This is the username you use to log into your UOM Account. Example: JSMITH

Staff OR Student ID Number This is the six-digit number on your staff or student ID card

Employment details

Academic division *

-- Please Select --Architecture, Building and PlanningArtsBusiness and EconomicsEducationEngineering and Information TechnologyFine Arts and MusicLawMedicine, Dentistry and Health SciencesScienceVeterinary and Agricultural SciencesOther (please specify below)ChancelleryChief Operating Officer Portfolio

If your academic division is not listed above, please specify:

Which of the following best describes your current teaching position? *

-- Please Select --Clinical tutorDemonstratorLecturerTutorGraduate researcherOther (please specify below)

If your teaching position is not listed above, please specify:

Cohort preferences

Please select which Cohort / study mode you prefer *

• Online Only - assessed mode (Weekly in March and May)
• Online Only - non-assessed mode (Weekly in March and May)

Have you previously attended any of the CSGT Seminars?

• Yes
• No

Please list all seminars and assignments you have previously completed, and which cohort you were enrolled in at the time of completion. You will need to provide this information if you are attempting to claim credit for prior attendance.

Acknowledgement

I understand that submission of this form does not confirm my eligibility, and that, upon submission of this form, I will receive more information about my eligibility, the program and its requirements. *

• Yes

If eligible, I agree to be enrolled in the Canvas subject. *

• Yes