Contact Sexual Harm Response Coordinators

First Name

Last Name

Preferred Name

Student Number

Email

Is it safe for you to be contacted via this email?

Phone Number

Is it safe for you to be contacted via this phone number?

Address

Date of Birth

Format: dd/mm/yyyy

What pronouns do you use?

For example: She/her, he/him, they/them or others

Are you a Domestic or International Student?

What type of study are you completing?

Do you have any disabilities you would like us to know about?

Please let us know if it will help us make arrangements for your access to the service

I need support with (select all that apply)

This list includes examples of issues we commonly support students with. If you need support with any other issue, please select "Other."

Please provide any additional details that you feel would be helpful to share with the Sexual Harm Response Coordinators

Has what you want to discuss happened within the last two weeks?

This question helps us understand which services can best support you. Some services offer crisis support to people who have experienced sexual assault within the past two weeks.

Privacy Collection Statement

The Sexual Harm Response Coordinators are a team of the University of Melbourne Student Union (UMSU). The UMSU Sexual Harm Response Coordinators manage personal and health information in accordance with the Information Privacy Act 2000 (Vic), the Health Records Act 2001 (Vic), and the Student Union Advocacy Service Confidentiality Policy. The information that we collect assists us to confirm your student status, contact and assist you, and is also aggregated into non-identifying statistics that facilitate our internal planning and review processes. We hold information on digital and paper based records, and take all reasonable steps to ensure that the information is accurate and complete and protected from misuse, loss, unauthorised access or disclosure. We will not disclose personal or health information to anyone without your permission, or unless permitted, or required by law. Should you wish to access information that we hold about you at any time, you may request access by speaking to the Manager, Advocacy & Legal. The information that we collect is stored securely for seven years and then destroyed. Our privacy policy is available on request.

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