Exit
Contact Sarah Finlayson with any queries 0417 780 684.

Question Title

* 1. Name

Question Title

* 2. Telephone number

Question Title

* 4. Address

Question Title

* 5. Professional Position

Question Title

* 6. Name of organisation where you are currently employed

Question Title

* 7. Have you completed an application for the Transition to Specialty Palliative Care Practice course?

Question Title

* 8. Name of the Post Graduate course you are enrolled in (if not the Transition to Specialty Practice Course)

Question Title

* 9. Name of Academic Institution (if not the Transition to Specialty Practice Course)

Question Title

* 10. Has the course/unit/subject been paid for in full?

Question Title

* 11. Please describe your role in relation to provision of palliative care?

Question Title

* 12. What are the expected outcomes of this professional development and how will it impact on your role, clients, carers and families and other professional stakeholders you work with?

Question Title

* 13. Declaration of course fee funding/subsidy received from another source. Please tick the correct response.

Question Title

* 14. Please provide the name and e-mail of your Manager if you are applying to undertake the course during work hours and/or if your organisation is funding all or part of the course.

Question Title

* 15. Declaration

T