Indigenous Pathway to Medicine Application

For Aboriginal and Torres Strait Islander applicants

Please note that by completing this form you are applying for consideration for the Doctor of Medicine (MD) at the University of Notre Dame Australia.

The following criteria will be considered:

Program Preference

Please indicate your preference below by typing ‘1’ next to your ﬁrst preference , ‘2’ next to your second preference and so on.
If you are applying for only one option, simply list '1' next to it and leave the others blank.

	MD School of Medicine, Sydney
	MD School of Medicine, Fremantle
	MD, Broome Kimberley Centre for Remote Medical Training (KCRMT)

Personal Information

First name	Middle name
Last name	Date of birth Day Month Year
Gender	Phone/mobile
Email
Residential address
Number and street name	Town/Suburbs
State	Postcode
Country
Mailing address (if different from residential address)
Number and street name	Town/Suburbs
State	Postcode
Country

Aboriginality

An Australia Aboriginal or Torres Strait Islander person is a person of Aboriginal or Torres Strait Islander descent who identiﬁes as an Aboriginal or Torres Strait Islander person and is accepted as such by the community in which they live or have lived.

A confirmation/Certificate of Aboriginality is a certificate or letter issued from an Aboriginal Land Council (LALC) on letterhead, signed by the LALC Chairperson or the Chief Executive Officer confirming the applicant’s acceptance as a LALC member; or a letter from an incorporated Aboriginal organisation where you live or your family is known stamped with their common seal as confirmation of Aboriginality.

I am an Aboriginal applicant	Do you have your Confirmation of Aboriginality?
Family or Group/Community name/details	Clan/Nation or Language Group details

Referee who is an Aboriginal or Torres Strait Islander person

This reference cannot be a family member.
Please list the contact details for an Aboriginal or Torres Strait Islander person who can verify your Aboriginality.

Full name
Role/Position	Phone
Referee address	How does this person or organisation know the applicant?

Education Background

As the Doctor of Medicine is a postgraduate degree, students must have successfully completed an undergraduate degree within the past ten years. An Official Transcript with evidence of degree completion must be submitted with the application.

Please list your previous undergraduate degree/s:

Degree name	Institution	Year completed
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Are you currently enrolled or have previously been enrolled in an MBBS, MD or equivalent at any university in Australia or elsewhere?

Have you ever been under exclusion from any university?

If Yes, was it a medical course?

Rurality

Have you resided for 5 years consecutively or 10 years cumulatively, or more, in rural or regional Australia since birth?

GAMSAT score (optional but encouraged)

The Graduate Australian Medical School Admissions Test (GAMSAT) has been developed by the Australian Council for Educational Research (ACER) in conjunction with the Consortium of Graduate Medical Schools to assist in the selection of students to graduate-entry medical programs at participating schools. GAMSAT is designed to assess a student’s capacity to undertake high level intellectual studies in a demanding course.

Have you completed GAMSAT in last 4 years?

If yes, please provide GAMSAT ID and attach your official GAMSAT results to this application form.

Supporting Documentations

Certiﬁcate/conﬁrmation of Aboriginality *
Transcript for completed degree and other academic records *
Resume/CV *
Confirmation of Rurality (if applicable)
Other supporting documents

Declaration

I declare that all information and documents I have provided are correct and complete. I have reviewed my application for accuracy.

If you experience any problems or have any questions regarding this form, please contact the Admissions Office on admissions@nd.edu.au.

The information provided in this form will only be used for the administrative or educational purposes of the University, or in accordance with your specific consent. The University will not disclose your personal information to a third party unless required to or permitted by law or where you have consented to the disclosure. Information relating to how the University collects, uses or discloses your personal information and how you may complain about the University’s handling of your personal information is contained in the University’s Privacy Policy.
You have a right to access your personal information that the University holds about you and to seek its correction. If you wish to access your personal information or inquire about the handling of your personal information, please contact Student Administration at student.admin@nd.edu.au