2015 Application Form Honours degree of the Bachelor of Health Science 3971

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1 2015 Application Form Honours degree of the Bachelor of Health Science 3971 Submission deadline: 31 October, 2014 Entry requirements To be considered for entry to the Honours Degree of the Bachelor of Health Science, students are required to have: Satisfied the requirements for completion of the Bachelor of Health Science degree; or a three or four year Australian Bachelor degree in any discipline; or an overseas qualification assessed as equivalent to an Australian Bachelor degree; and Undertaken and satisfactorily completed a minimum of 6 units at the highest level of the completed degree; and Obtained an average of at least 70% across all units at the highest level of the degree. Please note that these are the minimum entry requirements and do not guarantee entry. The application process is competitive and places are limited. Offers are made based on academic achievement and places are conditional on the availability of suitable supervisors. International students In addition to completing this application form, international students must also apply through Monash International Recruitment Services Non Monash domestic applicants Domestic applicants from outside Monash University must attach the following to this application: Proof of Australian citizenship or permanent residency. An original or certified copy of your current official academic record. Your final academic record and confirmation of completion of your degree must be provided as soon as they are available. An offer will not be confirmed until this information has been provided. Please fill out each section of this form CLEARLY and return to: Office use only Date received: Janet Christensen Senior Course Administration Officer School of Public Health and Preventive Medicine PO Box 197 Caulfield East Victoria, Australia, 3145 Level 4, Building F, Monash University Caulfield Campus, 900 Dandenong Rd., Caulfield East, VIC, 3145 Enquiries: (03) This is an application form only and does not constitute an enrolment for any course in the University, nor entitle an applicant to be classified as a student of the University. 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 & 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)

2 Student Name: This page has intentionally been left blank Updated 9/7/2014 Page 2 of 6

3 Student Name: SECTION 1: Student Details Applicant to complete Personal details Family name: Given Name(s): Date of Birth: DD/MM/YYYY Postal Address: Suburb: State: Postcode: Home telephone: Mobile: Have you previously applied and/or studied at Monash University? Yes No If yes, please provide Monash ID number (if known): Tertiary study Please indicate the details of your Bachelor Degree below. Non Monash applicants must attach a certified copy of your current official academic record to this application. Institution: Name of Course: *Year of Completion: *If you are currently awaiting results please state the date your final results will be available: Academic prizes and official publications Please list any academic prizes you have received and any papers you have had published in academic journals on a separate sheet and attach them to the back of your application. International Students only Have you submitted an application for the BHSc (Hon) through Monash International Recruitment Services? Yes No Note: International students must complete this application form as well as an application via Monash International Recruitment Services. Your application cannot be processed until both of these applications have been received. PLEASE READ BEFORE YOU COMPLETE ANY FURTHER SECTIONS OF THIS FORM If you have agreed upon a project with a potential supervisor, please complete the rest of this form. If you have not yet agreed upon a project with a potential supervisor, please tick the box below and complete sections 1, 2 and 3 only. Indicate your preferred project areas in the Brief synopsis area on the next page and leave the rest of section 2 blank. I have not yet identified and agreed upon a project with a potential supervisor. Updated 9/7/2014 Page 3 of 6

4 Student Name: SECTION 2: Project Details Applicant to complete Proposed thesis title: BRIEF synopsis (200 words) of your project: (or of the type of project you would like to work on) Main Monash Supervisor and Department where Supervisor is located: Location where proposed project will be undertaken: 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 you are at that location. Please include the names and contact details of any associate supervisors involved. Updated 9/7/2014 Page 4 of 6

5 SECTION 3: Student Declaration Applicant to complete Student Name: I declare that the information supplied on this form and the information given in support of my application is correct and complete. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application may result in the withdrawal of an offer of a place. I acknowledge Monash University reserves the right to seek from other relevant bodies, verification of the standing of my claimed qualifications. I have read the University's statement on privacy and the purposes for which my personal information will be used (available at I agree to be bound by the Statutes, regulations and policies of the University as amended from time to time and agree to pay all fees, levies and charges directly arising from my enrolment. I consent to receiving information electronically and agree to access the correspondence of my Monash University account on a regular basis. If selected for the Honours degree of the Bachelor of Health Science I consent to my fellow students and Supervisors having access to a listing including my full name and Monash student address. SECTION 4: Proposed supervisor to complete Guidelines for Admission to Candidature: An applicant for admission to candidature should a distinction average (i.e. 70% or more) across level three units of the Bachelor of Health Sciences (3882), or across the final level units of the student s undergraduate degree. Please advise that you are aware of the student s current average across their final level units, and provide any comment if necessary. Ethics Approvals: Will the project require ethics clearance from the relevant committee? (Please note: all 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* Yes No To be determined Yes No *(recombinant DNA technology) Updated 9/7/2014 Page 5 of 6

6 SECTION 5: Staff Approval Relevant staff members to complete Student Name: It is an expectation that funding allocations for hosting a BHealthSci (Hons) student be negotiated by the Head of the hosting Department and the Supervisor/s prior to this form being completed. By completing this form, you are agreeing to host a BHSc (Hons) student should their application be successful. Main Supervisor (Must be a Monash staff member) Name: Academic Unit: Mailing Address: Phone No: External Supervisor (if applicable) If the student is completing the BHSc (Hons) outside of Monash University, this information must be completed. Name: Academic Unit: Mailing Address: Phone No: Head of Hosting Department (Complete only if the hosting department is NOT the Department of Epidemiology and Preventive Medicine, Monash University) Name: Academic Unit: Mailing Address: Phone No: Updated 9/7/2014 Page 6 of 6

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