You will need to complete a travel booking form a minimum of six weeks prior to departure

The JFPP pays for travel to and from your placement community via the most economical means of transport which includes plane, bus, train or ferry. If you decide to drive to your placement so that you have transport during your stay, you will be reimbursed a comparative petrol allowance calculated by comparing the most economical means of travel against the Government fuel rate. Only the most economical cost will be reimbursed. Any additional costs incurred eg accommodation, whilst driving are your responsibility and will not be covered by the program.

Please note that the booking form is confirmation of your travel requirements and will be regarded as approval to book and purchase your ticket for travel. This means that you’ll need to be certain of your travel requirements prior to booking. Once booked, any changes will incur additional charges at your own expense.

Any changes to your confirmed Itinerary will incur costs to yourself. Please ensure that the information detailed below is correct.

Confirmation: *

I have read and understood the above statements

Indemnity Insurance Details

This is a mandatory requirement. Please upload a copy of your indemnity insurance cover dated for the period to cover your JFPP placement. You can not proceed with your travel request unless this step has been completed.

Upload indemnity insurance cover: *

I have attached a copy of my indemnity insurance to cover the dates of my placement.: *

YES

Personal Information and Contact Details

(As per photo ID that will be used to obtain tickets and/or boarding pass for travel)

Title: *

First name (as per photo identification): *

Last name (as per photo identification): *

University Name: * - Select -ADELAIDEANUBONDDEAKINFLINDERSGRIFFITHJCUMELBOURNEMONASHNEWCASTLENOTRE DAME FREMANTLENOTRE DAME SYDNEYUNSWUNEUQUSYDUTASUWAWESTERN SYDNEYWOLLONGONG

Student Number: *

Personal Mobile Number: *

Home Phone Number: *

Please include area code.

Out of Semester Contact Number: *

Please include area code if applicable.

E-mail Address: *

Emergency Out of Semester Contact Details

While on placement, if I am injured/ill please contact the following person (this is a mandatory field).

Contact Person: *

Relationship to student: *

Home Telephone: *

Please include area code.

Work Telephone: *

Please include area code.

Mobile Telephone: *

Street Address: *

City/Town: *

State: * - Select -ACTQLDNSWNTSATASVICWA

Postcode: *

Placement Information

Mentors Name: *

Practice Name: *

Practice Address: *

Practice City/Town: *

State: * - Select -ACTQLDNSWNTSATASVICWA

Postcode: *

Please Note:

You must be in your community on placement for a minimum of 14 nights. Extra time may be required to travel to and from your community. This will be indicated in the 'Travel Booking' section later in this form. Contact the JFPP if this is not possible, do not proceed with booking.

Placement Start Date (JFPP Info only): *

Day12345678910111213141516171819202122232425262728293031

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year20112012201320142015

Please note: This is the date of your first night in your community.

Placement End Date (JFPP Info only): *

Day12345678910111213141516171819202122232425262728293031

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year20112012201320142015

Please note: This is the date of your last day in your community.

Are you combining this placement with your university rotation?: *

YES (Please Note: You must obtain prior approval from your university and the JFPP team. A letter of approval from the university is required. )

NO

Have you confirmed your placement with your Mentor?: *

YES

NO (Please Note: If you have not confirmed your placement with your Mentor, do not proceed)

Have you discussed the 'Placement Planning Guide' with your Mentor?:

YES

NO (Please note - completion of this form will ensure you gain the very most from your placement. Click on the link below to access the JFPP Planning Guide and complete before going on placement.

JFPP Placement Planner 2011

 

Community Contact Information

Please fill in ALL details below, where applicable.

Have you been provided a Community Contact?: *

YES

NO

If yes, have you contacted your Community Contact?: *

YES

NO (Please Note: If you have not yet contacted your Community Contact, you must do so as soon as possible before commencing your placement.)

Community Contact Name (if known):

If you have been notified of your Community Contact, please provide their name here.

Community Contact Phone Number:

Please include area code.

If you have not been provided a Community Contact, is there someone in the community that has been helpful on your previous placements? Please provide their name & contact details:

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