Direct Admission Application Form Honours degree of Bachelor of Medical Science (0041)

Transcription

1 Medicine, Nursing and Health Sciences Direct Admission Application Form Honours degree of Bachelor of Medical Science (0041) This is an application form only and does not constitute project authorization. The form should be completed and lodged with your Supervisor and the head of the appropriate academic unit in which candidature is sought. Following signed endorsement by the Supervisor and head of the academic unit, the candidate is required to apply for a place via E-Admissions. This form must be uploaded in portable document format (pdf) to your application. Application to: Submission deadline: 30 May, 2014 Please CLEARLY fill out each section of this form, as the information supplied is required by the BMedSc administration team. Section 1 To be completed by the Applicant ID No: Family name: Current year of Medical Course: Title: Given name: Mailing address: address: Contact telephone: Mobile number: Academic Unit in which candidature is sought (Department of Main Monash Supervisor) and School: BRIEF reason for wanting to enrol in the BMedSc(Hons):

2 Student Declaration: (please strike out the relevant clause below if you do not consent) If selected for the Honours degree of Bachelor of Medical Science: 1. I consent to my fellow students and Supervisors having access to a listing including my full name, title of project and Monash student address. 2. I consent to the Medical Research Student Society (MRSS) having access to my Monash student address for distribution of upcoming meetings, etc. 3. I warrant that the information on this form, or provided in support of my application, is correct and complete. 4. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application, including academic transcript/s, might invalidate my application and that the University may withdraw an offer of a place or cancel my enrolment in consequence. 5. Should the University determine that I have submitted a false document, I consent to the University disclosing this information to other relevant tertiary institutions. 6. I consent to any educational institution at which I am or have been a student and/or any current or past employer providing Monash University with any information which that institution or employer holds about me concerning my attendance, conduct, grades and/or qualifications or experience to assess my suitability for an offer and/or enrolment. 7. I have read the University s statement on privacy and the purposes for which my personal information will be used (available at 8. If sponsored, I permit Monash University to release details of my academic progress to my sponsoring body on their request. I agree to abide by the statutes, regulations and policies of Monash University. 9. If I am an international student from a partner university, I confirm that I will not undertake any activities as part of this course which include : 1. Undertaking exposure prone procedures; or 2. Requiring patient interaction in a hospital environment Privacy Statement: The information on this form is collected for the primary purpose of assessing your application. Other purposes of collection include attending to administrative matters, statistical analyses and the creation of an enrolment record on the student database corresponding with you. If you choose not to complete all the questions on this form, it may not be possible for the Faculty of Medicine, Nursing and Health Sciences to assess your application. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact the University Privacy Officer on (03) Direct Admission Form Honours degree of Bachelor of Medical Science

3 Section 2: Honours degree of Bachelor of Medical Science Research Title and Synopsis To be completed by the Applicant Proposed research title: School or Academic Unit Project Synopsis: Please attach a summary of words. Note: ALL BMedSc(Hons) projects, including those with external research institutions and univeristies, require ethics clearance or an exemption from the relevant Monash ethics committee. Please note BMedSc(Hons) candidates do NOT undertake quality reviews, they are doing RESEARCH. Student signature: Direct Admission Form Honours degree of Bachelor of Medical Science

4 Section 3 To be completed by the Monash Head of Academic Unit/School in consultation with Main Supervisor Research proposal Please comment on the candidate s proposed research program with particular reference to its feasibility and the methods to be employed, including any requirement for particular facilities (such as travel, library, equipment or other resources). Please indicate whether the candidate is expected to use material and resources outside Monash University. Give details of any outside sources (eg name of institution) and travel that will be necessary. Please attach additional documentation where necessary. Location of BMedSc(Hons) Project: Physical site from where student will work: If any of the work to be undertaken will be conducted at a location other than a Monash University academic unit or recognised affiliated site, please indicate below what supervision arrangements will apply whilst the student is at that location. Please include the names and appointments of any associate supervisors involved. FMNHS School: Please state which Monash School you are attached to: Direct Admission Form Honours degree of Bachelor of Medical Science (0041)

5 Ethics Clearances Monash Ethics Research Approval is required for all BMedSc placements. Human Ethics (human, tissue, data) Authorisation Number (or anticipated submission date) Animal Ethics (animal, tissue, data) Authorisation Number (or anticipated submission date) Ionising Radiation ethics Authorisation Number (or anticipated submission date) Biosafety* *(recombinant DNA technology) Authorisation Number (or anticipated submission date) Ethics Authorisation Will the project require ethics clearance from the relevant committee? (projects involving questionnaires, interviews and surveys are subject to human ethics clearance). Approval required Approval obtained (if necessary) Human ethics Yes No To be determined Yes No Animal ethics Yes No To be determined Yes No Ionising radiation Yes No To be determined Yes No Biosafety* *(recombinant DNA technology) Yes No To be determined Yes No Research Project and Ethics confirmation Head of Monash School/Academic Unit Name (please print): Main Monash Supervisor Name (please print): Position Title: Mailing Address: State: Postcode: Phone: (w) Mobile: 2014 Direct Admission Form Honours degree of Bachelor of Medical Science (0041) 5

6 Section 4 Additional information for the Monash Head of Academic Unit and Chief Monash Super visor to consider before approving placement. Supervision Agreement Once a candidate confirms acceptance of a place in the course, the Course Administrator will coordinate the Supervision Agreement between the Course Management Committee and Monash Supervisor for authorization. This agreement outlines the minimum expectations of the CMC with regards to BMedSc(Hons) supervision. Course Guides and dates will be posted on Moodle by the end of July Examiners (Literature Review and Thesis) One appropriate examiner is to be to be arranged by the Monash Supervisor (Requests for nomination of suitable examiner will be sent to supervisors later in the year), the second examiner will come from BMedSc(Hons) supervisors as allocated by the CMC. Please note the honours year literature review and thesis is an exercise in communication, supervisors can mark any literature review or thesis (except that of their own student) they do not need to be an expert in the research field that they are examining. Unit Guide The Unit Guide will be available to view from Moodle by the end of July Assessment Details MBBS stream Literature Review and Examiners (28 November, 2014) In addition to the research component all students must undertake a literature review. At least two examiners, other than the supervisor or any person who has worked with the student (eg: in the same laboratory) or contributed to the research, are required to assess the thesis. Oral Presentations (1st Oral Examination 12 December, 2014/ 2nd Oral Examination 1 April, 2015) Students are also expected to make 2 department oral presentations on the research project throughout the course of the year. Presentations to the department (or equivalent) will need to be assessed by at least 3 members other than the supervisor. The examination panel must be arranged by the Monash-Linked Supervisor and the examiner reports sent to the course administrator by the due date. Mid Year Progress Report (12 December, 2014) The report must be read by and discussed with the student before signing and submitting. Thesis and Examiners (6 May, 2015) The research component is to be assessed by minor thesis. At least two examiners, other than the supervisor or any person who has worked with the student (eg: in the same laboratory) or contributed to the research, are required to assess the thesis. One appropriate examiner is to be to be arranged by the Monash Supervisor, (requests for nomination of suitable examiner will be sent to supervisors later in the year). The second examiner will come from the current BMedSc(Hons) Supervisor group as allocated by the Course Management Committee (CMC). Please note honours year thesis is an exercise in communication, supervisors can mark any thesis (except that of their own student) they do not need to be an expert in the research field that they are examining. Faculty Presentation and Scientific Poster 30 th April 2015 and 1 st May, 2015 A final presentation and scientific poster will be made to the Faculty over two days: 30 th April and 1st May, *Oral Presentation (5 min) will be assesed by CMC members and appointees (6 November). **Scientific Poster examiners to comprise CMC members, BMedSc(Hons) supervisors and expert examiners as identified by the CMC (1 st May, 2015) Direct Admission Form Honours degree of Bachelor of Medical Science (0041)

7 Department Approval to host BMedSc(Hons) student Please CLEARLY fill out each section of this form, as the information supplied is required by the BMedSc(Hons) administration team. Note to Staff: Submission of the form indicates your agreement to host a BMedSc(Hons) candidate, should their application be successful, and to meet all associated project and infrastructure costs. Faculty subsidies are paid directly to Monash Schools. The Faculty distributes funding for the BMedSc(Hons) in an identical fashion to the distribution of other teaching funding. Monies are distributed in the year following the student s candidature, following the appropriate deduction of Central and Faculty charges. The BMedSc(Hons) Course Management Committee, Course Convenor and Course Administrator have no role in the distribution of these funds and are unable to answer questions regarding these matters as it not part of their purview. If you have a query about funding, it is suggested you take this matter up with your Head of School, Head of Department or School/Department Finance Office, as appropriate. **If you are an Adjunct Monash staff member and you are based at the Baker IDI, Burnet Institute or the Alfred, please ensure you indicate which Monash School you are attached to (in most cases this will be Central Clinical School or The School of Public Health and Preventive Medicine. FMN&HS School: Guidelines for Admission to Candidature: An applicant for admission to candidature should have a good overall academic record and at least a credit average for units completed in the MBBS program. Please comment on the intellectual and motivational abilities of the applicant in relation to their proposed study: Head of Department Name (inc. title): Academic Unit: Mailing Address: State: Postcode: address: Phone: (w) Mobile: Direct Admission Form Honours degree of Bachelor of Medical Science (0041)

8 Chief Supervisor (Must be Monash staff member) If I am an international student from a partner university, I confirm that I will not undertake any activities as part of this course which include : 1. Undertaking exposure prone procedures; or 2. Requiring patient interaction in a hospital environment Name (inc. title): Academic Unit: Mailing Address: State: Postcode: address: Phone: (w) Mobile: Should the student be completing the BMedSc(Hons) outside of Monash University, please ensure the External Co Supervisor or the Monash-linked Co-Supervisor details are completed. If applicable, please CLEARLY fill out each section of this form, as the information supplied is required by the BMedSc(Hons) administration team. Co-Supervisor M onashuniversity External Name (inc. title): Academic Unit: Mailing Address: State: Postcode: address: Phone: (w) Mobile: Applications close: 30 May, 2014 Please apply online via E Admissions: Direct Admission Form Honours degree of Bachelor of Medical Science