APPLICATION FOR ADMISSION TO IMMUNOLOGY OR
INFECTIOUS DISEASES
HONOURS
(insert year of proposed study)
Personal Details:
Name:
Student ID:
Degree Program (eg BSc, BMEDSc):
Contact Information:
Email:
Mobile:
Term Time Contact Information:
Mailing Address:
Telephone:
Vacation Time Contact Information:
Mailing Address:
Telephone:
Projects in which you have a special interest (please list in order of preference)
1
Supervisor contacted
Yes
No
Supervisor contacted
Yes
No
Supervisor contacted
Yes
No
Supervisor contacted
Yes
No
2
3
4
Are you applying for HONOURS IN INFECTIOUS DISEASES
Yes
No
Are you applying for HONOURS IN IMMUNOLOGY?
Yes
No
Is Infectious Diseases Honours your first preference?
Yes
No
Is Immunology Honours your first preference?
Yes
No
Are you applying for Honours courses in other subjects?
Yes
No
If yes, which subject(s):
Which is your FIRST preference Honours Program?
ARE YOU APPLYING FOR OTHER COURSE(S) eg GRADUATE MEDICAL
PROGRAM, MASTERS/GRADUATE DIPLOMA
Yes
No
If Yes, which course(s):
Please indicate when you will be notified if your application in other program(s) is/are
successful:
SUPPORTING DOCUMENTATION
Please attach a copy of your academic transcript and a brief CV.
SUBMISSION
Please submit your application together with your academic transcript and CV to Dr Jamie
Triccas, Infectious Diseases and Immunology, Level 6 Blackburn Building D06 on or before
last Friday in October of the year before you intend completing Honours program.
Successful applicants will be notified in late December.