Student Placement Form

1

Full Name (as appears on Passport / Visa / Student Card):

First Name

Last Name

2

Mobile Number

Please enter a valid phone number.

3

Email Address

example@example.com

4

Are you a high school student?

YESNO

5

Which course are you currently enrolled in? (e.g. Certificate III in Individual Support, Bachelor of Nursing)If you are a high school student, indicate your current year level (e.g. Year 10)

6

What school, university, or registered training organisation are you studying at? e.g. The Pond High School / TAFE / University of Wollongong etc

7

Please provide your Placement Coordinator's name* This field is required.e.g. John Smith

8

Please provide your Placement Coordinator's email address * This field is required.e.g. jsmith@ABCUniversity.edu.au

9

When do you need the placement to start?e.g. 20 February 2024

10

How many total placement hours do you need to complete?e.g. 120 hours / for high school students, if this is not applicable please type "NA"

12

Which state do you live in?

NSW

ACT

WA

13

Which BaptistCare service are you interested in?

17

Which BaptistCare service are you interested in?

18

Which location/s are you interested inPlease choose a maximum of two locations below.

Griffith, 2603

Red Hill, 2603

19

Which location/s are you interested inPlease choose a maximum of two locations below.

Griffith, 2603

Red Hill, 2603

20

Which BaptistCare service are you interested in?