Student Membership Information
Please complete the below fields
Preferred Title
Mr/Mrs/Miss/Ms/Dr/Prof etc
Name
*
First Name
Surname
Gender
Male
Female
Non Binary
Prefer not to say
Other - I use a different term
Pronouns (optional)
Student email address
*
example@uon.edu.au
Student number
*
Cxxxxxxx
Phone number (landline and/or mobile)
-
Area Code + Landline/softphone
Mobile
Instagram Handle
LinkedIn Handle
BlueSky Handle
Degree enrolled in
*
School (at University of Newcastle)
*
Biomedical Science & Pharmacy
Medicine & Public Health
Psychology
Engineering
Health Sciences
Nursing & Midwifery
Other
Campus you are based at
For HDR Students, have you already registered as an HMRI Program Affiliate?
Yes
No - please complete the HMRI affiliate application via the link below and be sure to select Brain Neuromodulation as your program
Not applicable (I am not a HDR student)
HMRI - Become an Affiliate
Primary supervisor (if applicable)
Other supervisor(s) (if applicable)
Project title (for Honours or HDR students)
Hours Enrolled
Full Time
Part Time
Date Degree Commenced (approximate date is fine if you aren't sure)
-
Month
-
Day
Year
Date
Expected completion date (approximate date is fine if you aren't sure)
-
Month
-
Day
Year
Date
Research Keywords
*
How did you hear about the Brain Health Research Program?
Please follow our social media pages to learn more about the program
SUBMIT
Should be Empty: