Tel: 03 9905 2700 / 03 9905 2911
Email:
EXPRESSION OF INTEREST FORM – 2018
Extending Mathematical Understanding (EMU)
Intervention Specialist Teacher Course Early Years (6 days)
First Name Surname
Address Suburb Postcode
Phone (H) (W) (Mobile)
Email Job Title:
In order for us to ensure the preferred location for delivery of future programs could you please indicate which is your preferred location. (Please note that this is not a guarantee that a program will be delivered from that site, and that there may be a price variation between sites)
I am interested in attending the program at the following location(s). Please tick as many sites as you would consider.
Monash University Clayton Campus o Ballarat o Melbourne CBD o I don’t mind o
Mail:Engagement Office
Faculty of Education
29 Ancora Imparo Way,
Clayton Campus
Wellington Road
Clayton VIC 3800 / Fax:
03 9905 2621
If sending fax by computer (VOIP fax),
include cardholder name & signature.
Do not include your credit card number
- card details will be taken over the phone. / Email:
If sending by email, please include
cardholder name & signature.
Do not include your credit card number -
card details will be taken over the phone.
Privacy Statement
The information on this form is collected for the primary purpose of assessing your application. Other purposes of collection include the creation of a record on the student database, attending to administrative matters, corresponding with you and statistical analyses. If you choose not to complete all the questions on this form, it may not be possible for the Faculty of Education to assess your application. Personal information may also be disclosed to the education institutions to make an informed decision about the application or matters that concern the student's enrolment. 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 about the handling of your personal information, please contact the University Privacy Officer on 9905 6011.