Student work placement application form

First name *

Last name *

Email *

Contact number *

Address *

Gender *

Placement details (including dates required) *

Room required/setting *

Hours to complete

Is this placement for a research subject or project?

Yes

No

Are you an Australian citizen or Permanent resident?

Yes

No

If no, what is your visa status?

Do you identify as Aboriginal or Torres Strait Islander?

Yes

No

First preferred location of placement

Second preferred location of placement

Third preferred location of placement

Name of your University/College/TAFE

Name of course and qualification you are currently studying

Workplace Coordinator's name and contact details

Have you worked at SDN previously or are you a current staff member?

Yes

No

If yes, please provide details

Have you been fully vaccinated against COVID?

Yes

No

Additional comments