USLC Research Yarn Expression of Interest
We invite expressions of interest from individuals who would like to participate in this research project.
1.
Full Name
2.
Preferred contact (Email and/or Phone Number)
3.
Nation Group
4.
Year of birth
5.
Gender
Nonbinary
Female
Male
Transgender
Prefer not to say
Prefer to self describe (please specify)
6.
What is your allied health profession?
7.
What is your position?
8.
What town and state are you located?
9.
What was your role in USLC?
Student
Team facilitator
Professional mentor
Cultural mentor
Judge
10.
What year did you participate as a
Year
Student
-- Select an option --
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Team facilitator
-- Select an option --
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Professional mentor
-- Select an option --
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Cultural mentor
-- Select an option --
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Judge
-- Select an option --
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
11.
Where is your current work setting?
Aboriginal and/or Torres Strait Islander Community-Controlled Health Service
Government health service (state/territory/federal)
Hospital or acute care
Private practice
Disability services
Education setting
Research or academic institution
Policy, advocacy or peak body
Other (please specify)