PRIORITY LIST Mindfulness for Academic Success 2025

Please complete this form to apply for the next program in 2025!

WHEN – Tuesday’s 9:30am – 10:30am – Begins Week 3 – 18/3/25

WHERE – Bedford Park Campus

Completion of this form does not guarantee a place and all participants will be confirmed prior to commencement.

You will be contacted by phone for a chat about the program to make sure you think it is a good fit for you! :-)

Name*

First NameLast Name

Student ID Number (begins with a 2)*

Mobile Phone Number*

Please enter a valid phone number.

Flinders student email address*

example@flinders.edu.au

Which degree/masters/PhD are you studying*

Domestic studentInternational student

How did you hear about this program?*

Are there any anticipated challenges or issues for you with regards to your participation in the program that the facilitators need be aware of?*

The course consists of 5 hour long weekly sessions and homework tasks which consist of weekly readings and home practice mediations. Is there anything that will get in the way of you participating fully? *

Privacy Collection Statement & Consent

Your personal information is being collected by or on behalf of Flinders University (ABN 65 542 596 200), to enable us to enrol you in the relevant wellbeing program that you have expressed an interest in and provide associated wellbeing services to you.

Flinders University handles your personal information in accordance with the Privacy Act 1988 and the Australian Privacy Principles (Privacy Act) and the Flinders University Privacy Policy (our Privacy Policy), a copy of which can be accessed online at https://www.flinders.edu.au/content/dam/documents/staff/policies/facilities-info-management/privacy-policy.pdf

Purpose of collection:

Your information is being collected for a lawful purpose related to Flinders University enrolling you in the wellbeing program and providing wellbeing services to you, including (but not limited to):

• processing your application for enrolment in the wellbeing program;

• providing you with information regarding the wellbeing program and other wellbeing services;

• contacting you in the process of administering, managing, maintaining and improving our services, processes and procedures; and

• meeting any applicable legal and regulatory requirements.

What may happen if we did not collect your personal information:

Without your personal information we may not be able to enrol you in the wellbeing program or provide you with all wellbeing services that may be available to you.

Disclosure

We understand how important it is to keep your information confidential and private and will only disclose your personal to third parties in circumstances including but not limited to:

• where we are required to disclose the information by law;

• where disclosure is warranted in order to prevent an imminent threat to your health or safety, or the health or safety of another person;

• where the disclosure is requested by authorities in connection with a criminal investigation;

• where we believe that disclosure is reasonably necessary in order to mitigate or prevent a foreseeable risk of harm to yourself or a third party;

• where a student is enrolled in a course where mandatory notification requirements to AHPRA apply, and we form the view that the student has an impairment that may place the public at risk of substantial harm, then a mandatory report to AHPRA may be required;

• marketing and data analytics with a view to improve our services; or

• As otherwise permitted under our Privacy Policy.

Where your information is shared with third parties it will be done only to the extent necessary to fulfil the purpose of the disclosure with all reasonable steps to be taken to ensure the recipient does not breach the Privacy Act and our Privacy Policy.

Overseas disclosure

We use digital data storage providers in overseas countries from time to time, as set out in our Privacy Policy. We have agreements with these digital data storage providers to ensure the protection of personal information they hold.

Other information

Please read our Privacy Policy for details about:

• how to contact us;

• how to access or correct personal information we hold about you;

• how to make a complaint about a privacy breach; and

• how to deal with privacy complaints.

Consent

By checking the box below, you confirm that:

1. you have read and understood the Privacy Collection Statement; and

2. you consent to Flinders University collecting, using and disclosing your personal information (including sensitive information) as described above and otherwise in accordance with our Privacy Policy.

1. I have read and understood the Privacy Collection Statement; and 2. I consent to Flinders University collecting, using and disclosing my personal information (including sensitive information) as described above and otherwise in accordance with our Privacy Policy.