Title:

Family Name:

First Name:

Staff Id No:

Gender :

Academic Staff :
Level

General Staff :
Hew Level

Position:

Department:

Faculty/Division:

Phone:

MBL Phone:

Fax:

Email:

Campus/Site:

WorkshopTitle:

Date(s):

Other:

Please specify any additional training requirements such as special needs, dietary requirements etc.

The Information collected on this form is collected for the primary purpose of processing your application to attend a Monash University training course or event. Other purposes of collection include communicating with you, program administration, reporting and de-indentified statistical analyses. The information may also be disclosed to a third party training provider (if relevant) for course delivery purposes. If you choose not to provide all the information requested on this form, it may not be possible for you to fulfil (or meet) your training requirements. 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 abut the handling of your personal information, please contact the University Privacy Officer on 9905 6011.