Accommodation Registration

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*

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: $ 0.00

Resident Membership

Price: $ 0.00

SECTION C: Reservation (Booking) for Residency

Arrival Date

DD

MM

YYYY

Arrival Time*

: HH

MM

Check-in from 2.00pm

Departure Date

DD

MM

YYYY

Number of people*

Room Type*

Residency Fee per Week*

Comments

Advance Payment of Residency Fee

Price: $ 0.00

Minimum two weeks when booked term of residency > 2 weeks

Room Bond

Price: $ 0.00

Key Bond*

Price: $ 0.00

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

Car Park*

Price: $ 0.00

$10 daily or from $190 monthly

Internet Access*

Price: $ 0.00

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

SECTION D: Association and College Garb

Grab our College Garb, please visit our Merchandise page.

SECTION E: Thank you for your donation

The Graduate Union is a charitable not for profit organisation established to support the advancement of education and wider public good. It holds Deductible Gift Recipient status. This means that your gift of A$2.00 or more is tax deductible. Please note that a donation is not a compulsory payment.

Payment Amount for Donation TOTAL

SECTION F: 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)*

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*

Please make sure you name your file as fullName_offer.pdf

Staff or Visitor Identification Number

SECTION G: 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 H: 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 I: Applicant Details

Birth

Country of Birth*

Town/City/Village of Birth*

Are you of Aboriginal or Torres Strait Islander heritage?*

No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both Aboriginal and Torres Strait Islander

Passport

Do you have a passport?*

Yes
No

Passport Number*

Country of Issue*

Date of Issue*

Expiry Date*

Driver's Licence

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

Yes
No

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	Email	Policy Expiry Date

Ambulance Subscription Number	Name of Company	Phone Number	Email	Policy Expiry Date

SECTION J: 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*

Online account

e.g., Facebook, Skype

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

Email

Online account

e.g., Facebook, Skype

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 K: 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
No

As far as I am aware, I do <u>not</u> 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 L: Dietary Requirements

The Graduate Union provides breakfast seven days a week and dinner five nights a week (Monday to Friday) from our college kitchen and canteen. Our college has our own chef and kitchen staff members who come to know and care about our Resident and Non-Resident Members. We provide, on average 300 meals per day; and on some days, up to 500. Within these considerations, we endeavour to meet the most common dietary requirements.
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 M: Tutor Position

We invite you to apply to join The Graduate Union Tutor Team of Resident Members who provide tutorials to non-residents (e.g., undergraduates and post-graduate university students, and secondary school students undertaking the Victorian Certificate of Education (VCE)). You can choose to give tutorials in your discipline of study or in one or more languages. If accepted as a tutor, The Graduate Union provides administrative support and the facilities for 10% of the tutorial fee. We encourage residents to become tutors - it enables a small income, and is good work experience and to include on your curriculum vitae or resume.
Visit the Tutor Program page on our website, fill in the details and submit. Once your details have been received we will approve your tutor application and it will be logged into our website.

SECTION N: Communications

The Graduate Union is proud to provide to members a monthly newsletter and the Melbourne Graduate periodical. These are made available to our international membership of graduates around the world.

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

Yes
No

SECTION O: Contribute to College

The international collegium of graduates of today is active. Its members realise the privileges and advantages of their education and experiences through life, and work together for societal good.

Graduate House have a Student Group Committee (GSA) that helps to organise social events.

We encourage all new residents to become members.

Membership is free of charge and you do not commit to anything but it helps secure external funding for the Committee.

The Student Group Committee is run by residents. The amount of time and effort put in varies: everything from helping out with one event to running for an executive position on the committee is appreciated and encouraged.

Would you like to become a member?*

Yes
No

Graduate House Student Group Committee

Web: https://www.facebook.com/groups/graduatehouseresidents/ Email: ghstudentsgroup@gmail.com

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

I was introduced by Member:

Name

Tick as many as apply

SECTION Q: GU Collegiate

On becoming a Resident Member, you join a collegium of international interdisciplinary graduates who are at various career stages, from early (studying to gain a doctorate or masters, working in a profession) through mid to late careers and family/caring duties or in retirement.

Resident and non-Resident Members come together for GU Collegiate functions to network with graduates from a variety of cultures, disciplines, experiences and ages. As a Resident Member you are entitled to attend these functions for free or at significantly reduced prices.

Please tick the functions that you would most likely attend.

SECTION R: The Graduate Union Scholarship

The Graduate Union Scholarships are available to provide financial support to residents of The Graduate Union who are undertaking a research or coursework post-graduate degree.

For more information on Awards and Opportunities, visit our Scholarships page.

SECTION S: Covid-19

Declaration by Resident of Graduate House Self-Quarantine (Self-isolation)

Dear Resident,

A State of Emergency was declared in Victoria on the 16^th March 2020 to combat COVID-19.

You must self-quarantine (self-isolate) for a period of at least 14 days if you have:
• arrived in Australia after midnight on 15 March 2020;
• been diagnosed with COVID-19; and/or
• been in contact with someone who has been diagnosed with COVID-19.

Self-quarantine (self-isolation) means that you must stay in your room at Graduate House (including Barkly Place and Barry Street). It means that you must NOT:
i. leave your room;
ii. invite anyone into your room; and
iii. use shared Graduate House facilities, such as the kitchen, dining room, library or games room.

You may need medical care while in isolation – please email admingh@graduatehouse.com.au or telephone 9347 3428 to discuss this need. We will then work with you to leave your room under STRICT supervision or assist you in giving access to a health professional to come to your room.

In an emergency, you may be required to evacuate. We ask that you try to keep at least 1.5m away from all other residents when evacuating and when gathering in the designated evacuation space.

We require your completion, signing and return of a DECLARATION.

Your privacy is important to us. In providing the information in this form, you consent to our collection, use, processing, transfer, and/or disclosure of your personal data, including any sensitive data, in accordance with all applicable laws for the purposes of:
• monitoring, evaluating, and responding to the COVID-19 outbreak;
• providing accommodation and services in Graduate House having regard to Public Health Agency guidelines, and, to the extent necessary, for the safety of our residents and staff; and
• providing information to Public Health Agencies, medical personnel and any other relevant governmental agency.

If you decide not to complete this declaration form, we reserve all rights to exclude you from residency at Graduate House and/or evict you from Graduate House.

Thank you for your understanding and cooperation.

Question 1: Are you required to self-quarantine because you arrived in Australia after midnight on 15 March 2020 or because of your travel history?*

Yes
No

Question 2: Have you had close contact with someone who is diagnosed with or suspected of having COVID-19 in the past 14 days?*

Yes
No

Question 3: Do you have any reason to believe that you have or may have COVID-19?*

Yes
No

Question 4: Have you been in self-isolation previously?*

Yes
No

Country of self-isolation:*

Start date of isolation:

DD

MM

YYYY

End date of isolation:

DD

MM

YYYY

Self-isolation

You have answered Yes in the question mentioned above and you MUST self-quarantine (self-isolate) for 14 days.

The degree to which we can support self-isolation varies across our accommodation wings:
Terrace wing (222-234 Leicester Street) – we are not able to support self-isolation in this wing at all as there are no bathrooms in these accommodation rooms.
Central wing and southern (Stella Langford) wing (210-220 Leicester Street) – we are able to support self-isolation through the provision of breakfast every day and dinner Monday to Friday delivered to your room.
Barry Street and Barkly Place – we are not able to support self-isolation at this time in this wing as we are not able to deliver meals safely. Self-isolation means that you are not able to leave your room – it is thus not possible for you to collect deliveries from the downstairs foyer.

You may also be required to self-isolate if you are already a resident, if you:
• become ill with COVID-19 related symptoms;
• are tested for or diagnosed with COVID-19;
• become aware of the need to self-quarantine while staying at Graduate House; or
• become aware of the need to self-quarantine within 14 days of your stay,

please inform us immediately by email admingh@graduatehouse.com.au or by telephone on 9347 3428 if any of the above occurs..

Please also follow the advice of https://www.dhhs.vic.gov.au/coronavirus.

*

Prefix First Last

Room No:*

Arrival date in Australia:*

DD

MM

YYYY

I agree that:*

Signature*

Date of signature*

Payment

Payment Amount TOTAL

$ 0.00

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:*

DD

MM

YYYY

I would like to give regularly through my selected payment option*

I agree to the Automatic Payment Service Agreement

Automatic Payment Service Agreement

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.

Free gift

Men's Polo	XL	XXL	XXXL	XXXXL
Men's T-shirt	S	M	L	XL	XXL	XXXL	XXXXL
Women's Polo	8	10	12	14	16
Women's T-shirt	12	14	16	18

2020 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

Name

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

Resident Membership Application

SECTION A: Applicant Details

SECTION B: Resident Membership

SECTION C: Reservation (Booking) for Residency

SECTION D: Association and College Garb

SECTION E: Thank you for your donation

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

SECTION G: Tertiary Education Qualifications

SECTION H: Referees

SECTION I: Applicant Details

SECTION J: Emergency Contact Details

SECTION K: Medical Information

SECTION L: Dietary Requirements

SECTION M: Tutor Position

SECTION N: Communications

SECTION O: Contribute to College

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

SECTION Q: GU Collegiate

SECTION R: The Graduate Union Scholarship

SECTION S: Covid-19

Payment

2020 Residential Agreement Terms and Conditions

About the person completing this form

About the donation

About the donor

Payment of the donation

Please direct cheque to The Graduate Union of The University of Melbourne Inc.

Amount

Your Details

Payment