Student Application - Electives

Important Notice

Important Notice for Elective Placement Period

Period	Submission Commencement	Submission Deadline	Review Period
University of Notre Dame MEDI6400 (27 October 2025 - 23 November 2025)	4 February 2025	7 March 2025	10 - 21 March 2025 (acceptance and submission to ND deadline 24 April 2025)
University of Notre Dame MEDI6300 (24 November 2025 - 25 January 2026)	4 February 2025	31 March 2025	24 March - 4 April 2025 (acceptance and submission to ND deadline 9 May 2025)
University of Western Australia and Summer Elective Period (applicable to Australian and International students) (24 November 2025 – 23 January 2026)	1 March 2025	1 August 2025	1 - 31 August 2025
Curtin Medical School (29 December 2025 - 23 January 2026)	1 March 2025	11 July 2025	14 - 25 July 2025 (acceptance and submission to CMS deadline 3 August 2025)

Personal Details

* First Name:

Middle Name:

* Family Name:

* Preferred Name:

* Title:

* Correspondence Address:

Home Address (if different from Correspondence Address):

* Country:

* Telephone: Please ensure you prefix the number with your country code.

* E-Mail Address:

* Date of Birth:

* Gender:

* Nationality:

* Passport Number:

Emergency Contact

* Emergency Contact Name:

* Emergency Contact Telephone:

* Emergency Contact Address:

* Emergency Contact Relationship:

Electives Details

* Please select the electives program you are applying for:

* Have you received notification of a confirmed two week RFDS placement?

* Please list your three preferred location/hospital in order (the maximum period is four weeks). Please note placements are ONLY during the periods indicated on the homepage. Placement requests outside these dates will NOT be considered.

* Total number of elective weeks (the maximum period is four weeks):

* Please indicate your preferred discipline/s to work in during your placement: GP ED Internal Medicine O&G Paediatrics I have no discipline preference - the site is more important. Other

* Please state in 500 words or less why you have chosen particular rural sites for your elective.

Please specify your three preferred elective dates:

* Elective from:

* To:

* Elective from:

* To:

* Elective from:

* To:

Have you contacted any department(s), if so, who/where?

Academic

* Current University/Medical School Name:

* Course Contact Name:

* Course Contact E-Mail:

* Present Year of Study:

* Year of Graduation:

* Month of Graduation:

* Student's Knowledge of English:

Fees

Students who are offered a placement will be charged a non-refundable placement fee which is paid online once details are confirmed:

International medical students: $1,000.00
Australian and NZ medical students: $220.00
UWA, Notre Dame Fremantle & Curtin Perth medical students: No fee

Documents

Documents required to be uploaded when submitting this Application:

A copy of the identification pages of your passport endorsed by your Faculty representative (not applicable for UWA, Notre Dame Fremantle or Curtin Perth medical students);
Proof of proficiency in written and spoken English — if not your first language, or your course is not taught in English, IELTS or TOEFL or a statement from your university. You must be able to understand, write and speak English competently;
A letter from your Faculty confirming your student status and level and in good standing;
Your current CV;
Any additional documentation you deem appropriate to submit.

* Choose documents: Tip! Hold the CTRL or ⌘ to select multiple documents.

Submission

By submitting this form, you:

agree that the specified fees are non-refundable; and
have supplied the correct information in the form; and
attached the required identity and eligibility documentation.

I agree with the specified terms of submission.

Please enter your e-mail address to receive a confirmation of the submission: