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* 1. Organisation name

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* 2. Organisation overview

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* 3. Postal address

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* 4. State/Territory

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* 5. Contact person (include name, email and phone number)

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* 6. What is your current employment (include job title and organisation name)?

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* 7. Please provide an overview of your proposed dementia-friendly communities' project.

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* 8. How does your project meet the aims of the Community Engagement Program?

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* 9. How does your project incorporate the key principals of dementia-friendly communities?

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* 10. How will your project include people living with dementia and their carers in the design and delivery of the project?

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* 11. What partnerships will be formed to deliver the project?

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* 12. Will your project serve one or more of the priority groups? Please provide details.

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* 13. Is there any other information relevant to this dementia-friendly communities project that you'd like to elaborate on?

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