Register

Title

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First Name
Last Name
Preferred Name
Gender

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Date of Birth
Street
Street 2
City
State Province
Zip Postcode
Country

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Phone Mobile Cell
Phone
Discipline

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University

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Are you undergraduate or post graduate?
Student Number

(A) I have read and agree to Deakin University' Privacy statement:

https://www.deakin.edu.au/footer/privacy

(B) I consent to Deakin Rural Health providing my personal details to Health Services and Real Estate Agents in the location of my placement for the purpose of assisting Deakin Rural Health in booking and managing my accommodation.

Acknowledgement of Collecting Personal Information Deakin University is collecting your personal information on this form for the primary purpose of registering you and creating your account with Deakin Rural Health. It will also use this information to manage accommodation bookings. For these purposes Deakin may also provide this information, if you have provided your consent, to Health Services and Real Estate Agents who assist with booking accommodation. You are not required to provide the information requested, however if the information is not provided, Deakin may not be able to assist you with accommodation. Deakin manages personal information it holds, including requests by individuals for access to their personal information, in accordance with the Privacy and Data Protection Act 2014 (Vic). Deakin’s Privacy Policy may be viewed on the Deakin University Policy Library. Information on privacy at Deakin is available at http://www.deakin.edu.au/footer/privacy. Questions about privacy may be directed to the Privacy Officer on (03) 5227 8524 or by email to privacy@deakin.edu.au