Application for Subject Credit Form - General Practice and Primary ...

Department of General Practice
CREDIT APPLICATION
Who should complete this form?
This form is for students enrolled in a course delivered by the Department of General Practice at
the University of Melbourne and who are seeking credit for studies undertaken prior to their
current enrolment.
Before you submit your credit application
You should carefully look at the learning objectives of the Postgraduate Diploma in Primary
Care Nursing subjects that you would like credit for and refer to the course information to
determine the relevance of your prior studies to your current course.
Course information: http://www.gp.unimelb.edu.au/prospective_students/pgrad/pcn.html
Postgraduate Studies Catalogue: https://psc.unimelb.edu.au/app/search/subject.html /
Deadline for submission
Credit applications must be submitted one week prior to the semester in which credit is sought.
i.e. for a semester 1 subject, submit one week before semester 1 teaching commences.
Send your completed application form to:
Postgraduate Co ordinator Phone: +61 3 8344 7275
Department of General Practice Fax: +61 3 9347 6136
The University of Melbourne
200 Berkeley Street
CARLTON VIC 3053
SECTION 1
APPLICANT INFORMATION
Personal details
Surname (Dr / Mr / Ms / Miss / Mrs) __________________________________________
Given names
Student ID number
Course
__________________________________________
__________________________________________
__________________________________________
Contact details
Address for correspondence
Home telephone
Work telephone
Mobile
Email
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________

SECTION 2
CREDIT INFORMATION
Complete this section with details of the subject/s to be considered for credit from your previous
education institution/s for which your application is based.
3.1 Name of previous education institution: ________________________________________
Subject Code
Subject Title
SECTION 3 DOCUMENT CHECKLIST
Please ensure that you have attached the following documents:
certified copy of academic transcript
key to results for academic transcript
SECTION 4
DECLARATION & AGREEMENT
I understand that the Department of General Practice at the University of Melbourne reserves
the right to offer specified or unspecified credit as it deems appropriate up to the maximum
credit permissible under the Credit Guidelines.
I declare that to the best of my knowledge the information supplied herein is current and
complete. I acknowledge that the provision of incorrect information or the withholding of
relevant information relating to my application may result in any approve credit being
withdrawn and that this withdrawal of credit may take place at any stage during the course I
undertake.
Applicant Signature
Date:
________________________________________________
________________________________________________
SECTION 5
AUTHORISATION – OFFICE USE ONLY
Application outcome (please circle) : approved rejected
Comments: ___________________________________________________________________
Subject Coordinator:
Name: ____________________ Signature: _____________________ Date: ________________
This document is a modified version of the Credit Application form developed by the School of Nursing, University of
Melbourne http://www.nursing.unimelb.edu.au/current_students/forms/Credit_application.pdf accessed in Feb 2008.