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* 1. Full Name:

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* 2. University ID:

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* 3. Mobile Phone Number:

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* 4. Email Address

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* 5. How Did You Find Out About This Program?

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* 6. Level of Study:

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* 7. Is English Your Usual spoken Language?

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* 8. Have You Attended ANU Counselling Centre Group Programs Before?

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* 9. Please tell us what you would like to gain from attending this Group Program / Workshop

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* 10. I confirm I can attend the following of the 4 available weeks

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