Application for Student Placement Name First Last Email PhoneYour age during placement* Under 18 years of age 18 years or over Clearances* I have all required Clearances I am yet to secure all required Clearances I am under 18 and do not require these Clearances Placements for people over 18 years requires a valid Working With Children Check, National Police Clearance Certificate and COVID-19 Vaccination Certificate. Name of Institution*Level & Course of Study*Placement Coordinator Contact Details (name, phone, email)*Areas of Interest*Please provide a description of the area of services you interested in completing the placement in eg Counselling Services, Clinical Services, Early Childhood, AdministrationPreferred Location*Adelaide CityNorthern SuburbsSothern SuburbsMid-NorthFlexiblePlacement duration (hours)*Preferred Start Date* Date Format: MM slash DD slash YYYY Anticipated End Date* Date Format: MM slash DD slash YYYY Supervision Arrangements*Do you require a supervisor of a specific discipline? If yes, what discipline? Why would you like to undertake a placement at Nunkuwarrin Yunti?*Limit of 2500 Characters What do you hope to gain from your placement?*Limit of 2500 Characters What are your learning objectives or other requirements stipulated by your learning institution?*Limit of 2500 Characters Consent* I agree that the information provided is accurate and that Nunkuwarrin Yunti will use and share this information internally to enable an assessment of the opportunity for a placement. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.