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Welcome to RMEA.
Let's get your accommodation all sorted out.
22
Questions
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1
Who will be paying for your Accommodation?
*
This field is required.
Please select personal if you are paying yourself.
Personal
Bond University
Griffith School of Dentistry
Griffith GP Block
Health Workforce QLD (JFPP)
SQRH
UQ
Unsure
Other
Personal
Bond University
Griffith School of Dentistry
Griffith GP Block
Health Workforce QLD (JFPP)
SQRH
UQ
Unsure
Other
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2
Please add below who will be paying for your accommodation
*
This field is required.
Please include organisation name, contact name, email & phone number
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3
Name
*
This field is required.
Enter your name
First Name
Last Name
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4
Gender
*
This field is required.
Female
Male
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5
Is your booking for study related purposes?
Are you completing a university placement?
Please Select
Yes
No
Please Select
Please Select
Yes
No
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6
I am a University Student
*
This field is required.
YES
NO
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7
Which university are you enrolled at
*
This field is required.
For the purposes of this placement and the use of the accommodation.
Australian Catholic University
Bond University
Griffith University
James Cook University
Monash University
Queensland University of Technology
Southern Cross University
University of Queensland
University of Southern Queensland
Other
Australian Catholic University
Bond University
Griffith University
James Cook University
Monash University
Queensland University of Technology
Southern Cross University
University of Queensland
University of Southern Queensland
Other
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8
"Other" University Name
*
This field is required.
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9
What is your student ID / student number?
*
This field is required.
e.g. s000000
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10
Student Type
*
This field is required.
Doctor of Medicine
JFPP (John Flynn Placement Program)
Dentistry & Oral Health (Dental Student)
Nursing &/or Midwifery
Physiotherapy
Pharmacy
Speech Pathology
Paramedicine
Medical Imaging
Occupational Therapy
Other
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11
Student Type Other
*
This field is required.
Please define the type of university you are. e.g. MBBS.
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12
Griffith University Doctor of Medicine Placement Type
*
This field is required.
Longlook
Rural Selective (7 week block)
Rural Elective (7 week block)
Rural GP Block (7 week block)
Rural Summer Observership
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13
I am a Queensland Health Employee
*
This field is required.
YES
NO
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14
QH Employee Details
*
This field is required.
QH Employee Number
Position Title
Hospital Based At
Department
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15
Employment Details
*
This field is required.
Employer Company Name
Position Title
Company Address
Company Phone Number
Manager Name
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16
What is your current residential address?
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Post Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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17
Contact Details
*
This field is required.
Please enter your mobile contact number and your email. Both are required.
Please enter your mobile number
Please enter your email
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18
Date of Birth
*
This field is required.
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19
In case of an Emergency
*
This field is required.
In case we cannot get in touch with you for emergency purposes, who can we contact?
Full name of person
Please enter their best contact number
Please enter their email
Relationship to you e.g. parent, colleague
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20
Which accommodation building are you seeking?
*
This field is required.
Beaudesert
Charleville
Chinchilla
Clifton
Dalby - New Street
Dalby - Swan Street
Goondiwindi
Gympie
Jandowae
Kingaroy
Miles
Millmerran
Palm Island
Roma
Stanthorpe
Toowoomba - North Street
Toowoomba - Swallow Court
Toowoomba (DDCTC Bunks / Hume Street)
Warwick
Beaudesert
Charleville
Chinchilla
Clifton
Dalby - New Street
Dalby - Swan Street
Goondiwindi
Gympie
Jandowae
Kingaroy
Miles
Millmerran
Palm Island
Roma
Stanthorpe
Toowoomba - North Street
Toowoomba - Swallow Court
Toowoomba (DDCTC Bunks / Hume Street)
Warwick
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21
Arrival & Departure Date
*
This field is required.
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22
Signature
By signing here, you acknowledge that the information you have provided is true and corrected at the time of submission.
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