Visiting Medical Elective Placement Application

Visiting Medical Elective Program Application

College of Medicine and Public Health
Applicant Details
Applicant Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Home Education Institution
Education Institution
Program of study
Course or Degree name
Expected Graduation date?

MonthDayYear
Date
Home institution placement contact
Placement contact email
example@example.com
How long is your institution's medical program (in years)?
How many weeks of placement are required by your institution?
Does your institution have an agreement in placement with Flinders University?
You can ask your home institution placement contact
Your home university will be required to sign an agreement with Flinders University outlining the responsibilities of each party and confirming that you will be covered by your home university's professional indemnity and public liability insurance for the duration of your placement. Students MUST be covered by their home university's insurance for the duration of their placement. A student's personal insurance is not sufficient.
I acknowledge the insurance and agreement requirement. If these requirements are not met, I acknowledge that the placement cannot proceed
Elective Placement Discipline Preferences
First Preference
Requirements
Second Preference
Requirements
Date Preference (clinical elective 4-6 week or clinical research 12 weeks)
- Applications currently open for Summer 26/27 ONLY
- If you are requesting a 4 or 5 week placement, please provide exact start and end dates within the block
- Please note: the 18 January to 26 February 2027 and 1 March to 9 April 2027 dates are approximate. They will be confirmed as soon as the 2027 calendar is final.
Placement block
* 18 January - 26 February and 1 March - 9 April 2027 dates are approximate
Exact dates
South Adelaide Local Health Network (SALHN) contact
Have you discussed this placement with a contact within the Southern Adelaide Local Health Network (SALHN) or a Rural or Remote hospital in SA?
Name of the contact
Title of the contact
Email of contact
example@example.com
File Upload

Upload your files below. The Confirmation Letter must be signed by your Home University confirming your full name, the current year/total years of your course, that you are currently enrolled and will remain enrolled during the entire elective period, that English is the medium of instruction and that during your elective period you will be covered by your Home University's insurance (as outlined in the pre-placement compliance checklist). In addition, for students students applying for the 12 week clinical research, the letter must confirm your active enrolment in a prescribed research and scholarship theme embedded in your medical program constituting a necessary curricular requirement.
Attach Confirmation Letter (requirements above, letter must include: name, current year, enrolment status, English language, insurance)

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Attach your University Transcript

Cancelof
Application Fee

Pay application fee via this link https://pay.flinders.edu.au/MPH048
Attach the Application Fee Payment Receipt

Cancelof
Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Visiting Medical Elective Program Application

Applicant Details

Home Education Institution

Elective Placement Discipline Preferences

South Adelaide Local Health Network (SALHN) contact

File Upload

Application Fee