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ICM 5 GP Placements - Student Information Form

Please complete the following information, which will be taken into consideration when organising your GP Clinical Placements. 

Please note that GP Placements are compulsory and take place on 3 full days spaced fortnightly from week 6/7 until week 11/12.  Poor attendance will result in inability to undertake the ICM 5 OSCE exam. Each student attends on EITHER Wednesdays from 10am-6pm OR Thursdays 9am - 5pm. 

As GP placements occur at many locations around metropolitan Melbourne and Geelong, it is NOT possible to guarantee that all students will be placed close to their place of residence.  

Students are NOT able to nominate the dates of their placements, as this is predetermined according to their ICM tutorial grouping.  Students are also not permitted to swap their placements with other students, unless due to exceptional circumstances and with written authorisation from the ICM Administrative Officer, Ms Aradhana Deoki. 

 

Personal details
Student ID
Gender     
Name
Term address
Street
Suburb
State
Postcode
Contact details
Home Phone
Mobile
Email
Emergency contact
Name
Phone
Other

Do you speak any languages other than English (fluently)?

Do you have access to a vehicle to travel to your placement?


Please note any other study or work commitments which would impact on your placement.

Do you have any other comments regarding your ability to attend the 3 full day GP placements?

Please remember it is important that you notify both this Department and Student Administration in writing if you change your address.  If you fail to do so, you may miss out on vital information regarding your course.

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