Privacy Collection Statement


The information on this form is being collected by Department of Rural Health (DRH), Faculty of Medicine, Dentistry and Health Sciences (MDHS), The University of Melbourne. You can contact us at 03 8344 6791.

The information you provide will be used to contact you in relation to the Going Rural Health program and the resources, activities and services available to you.  It will also be used to facilitate your application for financial assistance, training and other support services, and will be made available, in de-identified and aggregated form, to the Australian Government Department of Health to comply with DRH reporting requirements.

If you do not provide all the information requested on this form, it may not be possible to provide confirmation of attendance to training events, or certificates of attendance for training. It may also make you ineligible for some of the accommodation or financial support schemes provided via the Going Rural Health program.

Your information will be used by authorised staff for the purpose for which it was collected, and will be protected against unauthorised access and use. You may access any personal information you have provided to the University by contacting 03 8344 6791 or emailing

The University of Melbourne is committed to protecting personal information provided by you in accordance with the Privacy and Data Protection Act 2014 (Vic). All information collected by the University is governed by the University’s Privacy Policy. For further information about how the University deals with personal information, please refer to the University’s Privacy Policy or contact the University’s Privacy Officer at