Please read the Application Information before completing this form $10 Application Fee: payment attached payment made previously Child Details FAMILY NAME: NAME: ………………………………. FIRST …………………………………..………… DATE OF BIRTH: M F ……………………………… SEX: Family Details PARENT/GUARDIAN 1 FAMILY NAME: FIRST NAME: ………………………………………… ……………………………………...…… ADDRESS: …………………………………………………………………….……………………….………..…. SUBURB: ………………………………………………………………………… POSTCODE EMAIL: ..……………………………………………………………………………………………………….… PH. (H) (W) ………………………………… MOBILE …………………………… OCCUPATION: …………………………………………………………………………………….……………………… Is this parent a student at the University of Melbourne? Yes No Full time Part time If yes: student number: UGrad Grad RHD ► ………………………….……… Is this parent a staff member of the University of Melbourne? Yes No Full time Part time If yes: name of staff number: ► Department: …………………………………………… …………………… Are you a single parent? Yes No
Please read the Application Information before completing this form $10 Application Fee: payment attached payment made previously Child Details FAMILY NAME: ………………………………. FIRST NAME: …………………………………..………… DATE OF BIRTH: ……………………………… SEX: M F Family Details PARENT/GUARDIAN 1 FAMILY NAME: ………………………………………… FIRST NAME: ……………………………………...…… ADDRESS: …………………………………………………………………….……………………….………..…. SUBURB: ………………………………………………………………………… POSTCODE EMAIL: ..……………………………………………………………………………………………………….… PH. (H) (W) ………………………………… MOBILE …………………………… OCCUPATION: …………………………………………………………………………………….……………………… Is this parent a student at the University of Melbourne? Yes No Full time Part time ► If yes: student number: ………………………….……… UGrad Grad RHD Is this parent a staff member of the University of Melbourne? Yes No Full time Part time ► If yes: name of Department: …………………………………………… staff number: …………………… Are you a single parent? Yes No
2019-Waiting-List-Application-Form.docx