HomeRegister – Clinical Student Register – Clinical Student HiddenYour name Name First Last Date of birth MM slash DD slash YYYY GenderMaleFemaleOtherAre you of an Aboriginal or Torres Strait Islander background? Aboriginal Torres Strait Islander I do not identify as Aboriginal or Torres Strait Islander I would rather not say 2. Do you speak a language other than English (including AUSLAN or other sign language)? If yes, please list language/s spoken.What, if any, specific cultural or ethnic group do you belong to? Are you willing to be contacted regarding language and culture? Yes No Your nearest Rocky Bay hubMosman ParkCockburn CentralAscotClarksonGeraldtonGosnellsMandurahDuncraigRockinghamYour email* Your phone number Current study course Current year of studyPlease enter a number from 1 to 10.Current study institution Any previous experienceFuture career ambition/sSpecial skills or interestsEmergency contact name Emergency contact number Emergency contact relationship Any important medical information?Any allergies?How did you hear about Rocky Bay?List two goals for your coming placementFile upload* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB. Please upload: - A valid Working with Children Check - A National Police Clearance from within the past 3 months - A Covid-19 vaccination certificate - An influenza vaccination from the past 12 months - A copy if your driver’s license Name First Last EmailThis field is for validation purposes and should be left unchanged. Δ
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