Resident Application Form

Resident Membership Application Form

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Reservation number*

SECTION A: Applicant Details

Prefix*

First*

Middle

Last*

Date of Birth*

Email*

Second Email

Telephone (Home)*

Include country and area codes

Telephone (Mobile)*

Include country and area codes

Address for Correspondence*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home, postal or business address for direct mail

Permanent Residential Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Photograph for Identification Card*

Accepted file types: jpg, png, Max. file size: 2 MB.

Provide a passport-type photograph, preferably in .jpg format. The photograph is to be:
– high resolution
– in colour
– recent
– head and shoulders only
– with light background for better printing
– with a smile Please make sure you name your file as Photo.

SECTION B: Resident Membership

Membership of our prestigious 101 year old international collegium of graduates entitles you to reside in our Melbourne college and use our facilities. Membership is discounted for residents who are enrolled in a course of post-graduate study. The first membership fee includes a Joining Fee.

Resident Membership entitles you to free or reduced fee participation in the GU Collegiate events shown in Section Q.

Joining Fee

Price:

Resident Membership

Price:

SECTION C: Reservation (Booking) for Residency

This field is hidden when viewing the form

Arrival Date

Arrival Time*

Check-in from 2.00pm

This field is hidden when viewing the form

Departure Date

Number of people*

Room Type*

Residency Fee per Week*

Comments

Advance Payment of Residency Fee

Price:

Minimum two weeks when booked term of residency > 2 weeks

Room Bond

Price:

Key Bond*

Price:

Refundable within 14 days of departure date (subject to terms).

Car Park*

Price:

$10 daily or from $190 monthly

Internet Access*

Price:

$30 per month for 20GB; $40 per month for 50GB

SECTION D: Purpose of Visit to Reside at the Graduate Union

Purpose*

Study – enrolled for study

Other Purpose – e.g., sabbatical, research, teaching, etc.

University*

Faculty*

Department/School*

Academic Contact name*

Academic Contact email*

Academic Contact phone*

If enrolled for study, attach documentary evidence of enrolment (or letter of offer) to this application.

Evidence of enrolment (or letter of offer)*

Accepted file types: pdf, pdf, Max. file size: 128 MB.

Please make sure you name your file as fullName_enrolment.pdf

Student Identification Number*

Course code and name*

Expected date of graduation

Course dates

Year 1

Start Date*

End Date*

Year 2

Start Date

End Date

Year 3

Start Date

End Date

End-award*

(e.g., doctorate, professional doctorate, masters, diploma)

Purpose of visit*

Letter of offer/invite*

Accepted file types: pdf, pdf, Max. file size: 128 MB.

Please make sure you name your file as fullName_offer.pdf

Staff or Visitor Identification Number

SECTION E: Tertiary Education Qualifications

(for all new graduate Resident Members)

Full Name at Graduation*

First Degree

Year

Name of Degree Obtained

University

Other Degrees or Qualifications

Year

Qualification Obtained

University

SECTION F: Referees

Referees may be contacted at any time prior to or during the term of residency. Please provide details for professional or academic referees (e.g., lecturer, professor, employer, etc.)

Do not provide details for family members or friends.

Referee 1

Name*

Prefix First Last

How long has this referee known you?*

What is your relationship to this referee?*

(e.g., I was a student or employee of this person)

Referee 2

Name

Prefix First Last

How long has this referee known you?

What is your relationship to this referee?

(e.g., I was a student or employee of this person)

SECTION G: Applicant Details

Birth

Country of Birth*

Town/City/Village of Birth*

Are you of Aboriginal or Torres Strait Islander heritage?*

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, both Aboriginal and Torres Strait Islander

Passport

Do you have a passport?*

Yes

Passport Number*

Country of Issue*

Date of Issue*

Expiry Date*

Driver’s Licence

Do you have a Driver's Licence in any country?*

Yes

Licence Number*

Country of Issue*

Date of Issue*

Expiry Date*

Residency Status

Please choose your residency status in Australia*

Country of Citizenship*

Visa Type and Number*

Language

Other than English, I use the following languages at competency levels (Low, Medium or High):

Language

Competency in Speaking

Competency in Understanding

Competency in Writing

Competency in Reading

Insurance

Medicare Number

(for citizens of Australia only)

Private Insurance Number

Name of Company

Phone Number

Policy Expiry Date

Ambulance Subscription Number

Name of Company

Phone Number

Policy Expiry Date

SECTION H: Emergency Contact Details

In the event of an emergency The Graduate Union will endeavour to contact the first person listed to inform them of the emergency. If this person is not available, The Graduate Union will endeavour to contact the second emergency contact person listed. Please provide as much contact detail information as possible to ensure that we are best positioned to reach those who love and care about you.

Contact 1

Name*

Prefix First Last

Email*

What is your relationship to this contact?*

e.g., I am the daughter/son, friend or patient of this person

Telephone (Landline)*

Include country and area codes. For calls to overseas, provide best time to call.

Telephone (Mobile)*

Include country and area codes. For calls to overseas, provide best time to call.

Contact 2

Name

Prefix First Last

What is your relationship to this contact?

e.g., I am the daughter/son, friend or patient of this person

Telephone (Landline)

Telephone (Mobile)

Doctor in Melbourne
If you do not have a doctor in Melbourne you may like to register as a patient with a general practitioner or other health professional at: The University of Melbourne Student Health Services, 138-146 Cardigan Street, Carlton. Telephone: +61 3 8344 6904.

This is located within walking distance of The Graduate Union.

Doctor

Name

Prefix First Last

Telephone

Address for Doctor

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home, postal or business address for direct mail

SECTION I: Medical Information

It is recommended that you inform The Graduate Union of any condition that may affect your health, safety and comfort, or the health, safety and comfort of others during your residency. The Graduate Union recommends that you provide this information although its provision is not mandatory. It is collected to assist in providing appropriate residential facilities and services, and in the event of accident or emergency.

Information provided to The Graduate Union is subject to the Information Privacy Act 1988, Health Records Act 2001, Equal Opportunity Act 1995 and The Graduate Union’s Privacy Policy.

Are you willing to provide details about your health?*

Yes

Do you have any of the following:

(Tick one (at least) or more.)

Please provide details (e.g. of allergies)

If any of the options are ticked, please provide sufficient information to enable The Graduate Union to provide first aid care and to advise ambulance, paramedic and health care staff in the event of an emergency. This information is kept in your resident records and is treated as private and confidential. It is released only in the event of an emergency to the GU staff and emergency and health services personnel involved in administering care.

Additional documents can be attached to this section, such as care plans and the names and contact details of professionals in the care team; medication list, dosages and schedule; known emergency procedure – e.g., in the event of an epilepsy attack, an asthma attack, a psychotic episode, a severe episode of depression or anxiety, hypoglycaemia, etc.; and mobility requirements – e.g., for wheelchair use, bathroom aids, etc.

SECTION J: Dietary Requirements

The Graduate Union provides breakfast seven days a week and dinner five nights a week (Monday to Friday, except Public Holidays) from our college kitchen and bistro. Our college has our own chef and kitchen staff members who come to know and care about our Resident and Non-Resident Members.
Note: all meat is Halal.

Required Diet
(medical certificate required)

Please indicate the food that you cannot eat for health reasons (e.g., due to food allergy)

Dietary Preference

Please indicate the foods that you choose not to eat

SECTION K: Communications

Please indicate if you would like to receive correspondence and publications via Email.*

Yes

SECTION L: How did you learn about our association and college?

I was introduced by Member:

Name

Tick as many as apply

Payment

Payment Amount TOTAL

Payment*

Paying my own deposit (via Credit Card or Bank Transfer or Direct Debit)

Department is paying my account

Payment Method*

Debit/Credit Card

Bank Transfer

Direct Debit

Financial Institution*

Account Name:*

BSB:*

Account Number:*

Swift Code:

Start Date:*

Signature*

We acknowledge our Donors

I would like my donation to be anonymous and do not wish to have my name printed in any published lists.

We will send you a tax invoice (your donation is tax deductible) and include your name in donor lists. Check below if you do not wish to be so acknowledged.

Account Name: The Graduate Union of the University of Melbourne Incorporated
Bank: National Australia Bank
BSB: 083 170
Account Number: 51561 2137
Swift Code: NATAAU3303M
Name the transfer as your Surname and the word Resident Form. Please note that your application cannot be processed without receiving payment.

Contact Name*

Department*

Department Email*

Debit/Credit Card payments are provided by ‘Stripe’, a third party payment gateway. We do not store your credit card details, or have access to them.

Credit Card*

Card Details

Cardholder Name

The Graduate Union will confirm your Reservation within 14 days of receipt of payment.

Our FREE gift to you upon becoming a new member of The Graduate Union is a polo or t-shirt.
Indicate your preference for a polo (female or male) or t-shirt, and the size of garment required. Tick one option/size.

2024 Residential Agreement Terms and Conditions

I certify that the information provided by me, the applicant for residency, is correct, accurate and sufficient to enable The Graduate Union to serve reasonably my comfort and safety, and the comfort and safety of others during my residency.

I authorise The Graduate Union to consent to my receiving emergency medical or surgical treatment as may be deemed necessary, in the event that I am unable to communicate or The Graduate Union is unable to contact an immediate family member/emergency contact.

I authorise The Graduate Union to contact the emergency contacts listed in this form in the event of an emergency and as may be deemed necessary.

I confirm that I will notify The Graduate Union when any of the information changes, that I have provided in this Application Form before and during my term of residency.

I have read and agree to the Residential Agreement Terms and Conditions.

I have attached my letter of offer or other appropriate documentation from the university.

I have attached a digital photo of myself.

I hereby authorise The Graduate Union of The University of Melbourne Incorporated to settle any outstanding debts and penalty fees that I have not settled with cancellation of a confirmed reservation, with early departure from residency and/or prior to departure on my Reserved End Date.

I certify that I will not dispute settlement of outstanding debts and penalty fees that correspond to this Resident Membership Application Form and Residential Agreement Terms and Conditions with The Graduate Union of The University of Melbourne Incorporated.

I have read and understood the Privacy Policy shown at www.graduatehouse.com.au/membership/privacy-policy.

I commit to learn to state the 17 UN agreed 2030 Sustainable Development Goals www.undp.org/content/undp/en/home/librarypage/corporate/sustainable-development-goals-booklet.html

I hereby authorise The Graduate Union to use, reproduce, and publish photographs or videos that may pertain to me, including my image, likeness, or voice without compensation. I understand that this material may be used in various print and digital publications (The Graduate Union newsletter, Melbourne Graduate, Graduate House website and blog, and social media channels, and other marketing material relating to the Graduate Union and Graduate House). I understand that these materials may appear online or in print. This authorisation is continuous and may only be withdrawn by my specific rescission of this authorisation.

I agree to provide a signed copy of the Authorisation sheet within 48 hours of beginning my stay at The Graduate Union.

Details for Bank Transfer Account Name: The Graduate Union of the University of Melbourne Incorporated
Bank: National Australia Bank
BSB: 083 170
Account Number: 51561 2137
Swift Code: NATAAU3303M
Name the transfer as your Surname and the word Resident Form. Please note that your application cannot be processed without receiving payment.

The Graduate Union will confirm your Reservation within 14 days of receipt of payment.

Date

Resident Membership Application Form

SECTION A: Applicant Details

SECTION B: Resident Membership

SECTION C: Reservation (Booking) for Residency

SECTION D: Purpose of Visit to Reside at the Graduate Union

SECTION E: Tertiary Education Qualifications

SECTION F: Referees

SECTION G: Applicant Details

SECTION H: Emergency Contact Details

SECTION I: Medical Information

SECTION J: Dietary Requirements

SECTION K: Communications

SECTION L: How did you learn about our association and college?

Payment

2024 Residential Agreement Terms and Conditions

Donate to the Diamond Jubilee Campaign

Amount

Your Details

Payment