Miscellaneous
Request
Research Services
CRICOS Provider Number 00103D
PLEASE USE BLOCK LETTERS WHEN COMPLETING THIS FORM BY HAND.
There is no requirement for this form to be sighted by School staff. However, it is advisable to obtain at least one other
signature. This provides an opportunity for discussion and reflection. NOTE: A signature below does not imply
endorsement of your submission though comments from signatories are welcomed and may be appended.
It is the responsibility of the candidate to be conversant with current higher degree by research rules/regulations
governing his/her candidature (Regulation 5.1).
Name
Student Number
Contact Telephone
Course Name
3
0
Address
Suburb
State
Postcode
Email Address
Principal Supervisor
Campus
School
Gippsland / Ballarat (please circle)
NATURE OF REQUEST: (Additional information and supporting documentation can be attached to this form)
Have you discussed this
request with your:
Principal or Associate Supervisor/s?
Associate Dean (Research)?
Yes No
Yes No
Student Signature:
Date
ADDITIONAL SIGNATORIES
SIGNATURE
/
/
DATE
Principal Supervisor
Associate Dean (Research)*
*If ADR unavailable, Dean of School to sign.
CRICOS Provider No. 00103D
MRF
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