Occupational Health and Safety Course Enrolment Form

This enrolment is for MONASH staff & students wishing to enrol in an Occupational Health and Safety course.
Details of courses can be found in the A-Z listing of courses .

Please note that all enrolments must be submitted to Occupational Health & Safety no later than 5 working days prior to course commencement.

Course Details

	Course title:	Course code no:	Course date(s):	Cost:
1				$
2				$
3				$
4				$
5				$

Applicant details

Title (Mr, Ms, Dr etc):
Family name:
Given name:
I am a:	Staff member (manager) Staff member (supervisor) Staff member (other) Student (undergraduate) Student (postgraduate) Student (honours)
ID number:
Department:
Faculty:
Building no./name:
Campus:
OHS zone:
Telephone extension:
Email address:

Payment Options

If a course is fee paying, please ensure that correct cost centre and fund number details are provided. Failure to do so, may result in a delay to be enrolled into the course of your choice.

Payment option:

Account code:

734013
Cost Centre:
Fund:

Cheque

Cheque made out to Occupational Health, Safety & Environment

Invoice

Debtors invoice (For departments not on SAP)

No fee

Only select if fees are not applicable for this course

Approval

Authorised by (name):
Authoriser's telephone:
Declaration:	I have my supervisor's approval to attend this program

Cancellations

A full refund will only be provided by Occupational Health and Safety where notification is received no less than seven (7) days prior to the commencement of a course.
A 25% surcharge will be applied to those cancellations received no less than three (3) days prior to the commencement of a course.
No refund will be given for cancellations notified after such time as detailed above.

The information collected on this form is collected for the primary purpose of processing your application to attend a Monash University training course or event. Other purposes of collection include communicating with you, program administration, reporting and de-identified statistical analyses. The information may also be disclosed to a third party training provider (if relevant) for course delivery purposes. If you choose not to provide all of the information requested on this form, it may not be possible to meet your training requirements.

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 (03) 9905-6011.