Commonwealth Medical Internships2018– Student Application Form
MEDICAL STUDENT CMI APPLICATION FORM
Applications open 9.00am (AEST) on Monday, 14 August 2017 and close at 5.00pm (AEST) on Monday, 28August2017.
This form must be completed in full and emailed to . Incomplete applications may not be accepted. Applications received by the Department of Health after 5.00pm AEST onMonday,28 August2017will not be accepted.
Please ensure that your application is complete and accurate and that you have completed and dated the Declaration (Attachment A). It is preferable for you to type your full name in the signature line of the Declaration and submit theapplication electronically.
Participating in the Commonwealth Medical Internships (CMI) initiative:
The CMI initiative isopen to eligible international full-fee paying medical students from onshore medical schools. Eligible CMI candidates that accept a CMI place must enter into a legal agreement with the Commonwealth to complete their internship and a return of service period. A sample of the Deed of Agreement can be found at
Eligibility
Applicants must meet all eligibility requirements. Applicants must:
- be a full-fee paying international student completing their medical degree during the current calendar year from an onshore medical school in Australia, having completed all of their medical degree in Australia (short-term elective rotations completed offshore will not exclude applicants provided rotations have university approval); and
- have met the Medical Board of Australia (MBA) English language competency requirements for registration purposes (provisional registration as a medical practitioner cannot be obtained without meeting this standard); and
- not be an Australian Citizen; and
- commit to obtaining an appropriate visa to work in Australia during the internship year and as long as necessary to complete the return of service obligation (refer to the Department of Immigration and Border Protection website for details
The Department recognises that some applicants will only meet the MBA English language competency for registration purposes upon completion of their medical degree using the Combined secondary and tertiary education pathway and/or the Extended education pathway. Information is available for medical students in this situationin the CMI 2018Frequently Asked Questionsat:
Applicants who do not meet all eligibility criteria will be ruled ineligible.
You are not eligible for a CMI internship if:
- your medical degree was undertaken in an offshore campus of an Australian university, such as Monash Malaysia or as part of the UQ-Ochsner MBBS Program, or you commenced your medical degree at an overseas university such as the International Medical University and are completing the final part of your degree in Australia; or
- you have a return of service obligation to a country which has sponsored your university medical studies; or
- you are an Australian citizen; or
- you have already accepted an internship position from a state or territory for 2018; or
- you completed your medical degree in, or prior to, the 2016calendar year or are completing your medical degree in the 2018calendar year (eligible applicants from the previous calendar year who were not offered a CMI internship place or executed a Deed of Agreement and could not commence or needed to withdraw during their first rotation due to exceptional circumstances may be given approval to participate in the current CMI initiative on a case by case basis); or
- you have not met the MBA English language competency requirements at the time of application and you are not using Combined secondary and tertiary pathway and/or the Extended education pathway.
From the information you provide on this form, the Department of Health will assess youreligibility for a 2018Commonwealth Medical Internship. You are also required to sign and complete the declaration format Attachment A. Please note evenif you are found eligible to participate in the CMI initiative thatyou are not guaranteed an internshipposition with a hospital.
By providing the data below, you are agreeing that your information can be shared with stateand territory governments, participating hospitals, universities and other Commonwealth Government departments for the purpose of administering national internship offers, allocations and conducting research.
Title:Family name:
(as it appears on your current passport)
Given name:
(as it appears on your current passport)
Name you are known as/preferred name:
Gender:
Date of birth:
Nationality:
University from which you will obtain your medical degree:
Date/year you commenced your medical degree in Australia (attach documentation from your university verifying date):
Date/year you completed your English language requirements (attach supporting documentation verifying completion):
Method of meeting MBA English language competency requirements(attach supporting documentation verifying completion):
Combined secondary and tertiary education pathway
Extended education pathway
Primary language pathway
English language test pathway
Date/year you will complete (or completed) your medical degree in Australia:
Medical degree - Title of Qualification:
Your Intern Placement Number (as provided to you by your medical school):
Email address/es to communicate with you during 2017 and 2018:
Your current mailing address:
Your current telephone number Mobile:
Your current telephone number Landline:
Referee details (optional):
Preferred region in Australia for internship (optional):
Topic/s of interest for internship - in no more than 100 words (optional):
Attachment A - Declaration
You mustread the following statementsand sign the declaration belowto indicate acceptance and confirm that you meet all the eligibility requirements listed on page 1 for the CMI initiative.
I,...... (insert your full name)
1. attest that I am eligible for the Commonwealth Medical Internship initiative for2018as specified on page 1 of this application form; and
2. accept that there will be a legal requirement for me to complete my internship year and 48 weeks return of service in an Australian Standard Geographical Classification Remoteness area 2-5 location should I be successful in securing a Commonwealth funded medical internship; and
3. consent to the Department of Health collecting sensitive personal information (for example, my
nationality) for the purposes indicated above.
I declare that to the best of my knowledge the information I have given on this form is correct. I understand that giving false or misleading information is a serious offence.
Your signature*: ……………………………………………………………….
*Type your full name if submitting electronically
Date: ………………………………………………………………………….
IMPORTANT INFORMATION - Privacy and your personal information
Your personal information is protected by law, including the Privacy Act 1988, and is being collected by the Australian Government Department of Health for the purposes of determining eligibility for and administering the 2018Commonwealth Medical Internship initiative. If you do not provide this information you may be ineligible to receive a 2018Commonwealth Medical Internship place.
The Department may disclose all applicant information on this form to state and territory health departments, participating hospitals, universities, medical regulatory authorities and the Commonwealth Department of Immigration and Border Protection. The Department is unlikely to disclose your personal information to overseas recipients.
You can get more information about the way in which the Department of Health will manage your personal information, including the Department of Health’s privacy policy at You can obtain a copy of the privacy policy by contacting the Department by telephone on (02) 6289 1555 or freecall 1800 020 103 or by using the online enquiries form at The privacy policy contains information about:
- how you may access the personal information the Department holds about you and how you can
seek correction of it; and
- how you may complain about a breach of the Australian Privacy Principles, which regulate the
handling of personal information by Australian government agencies.
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