Palliative Care Australia (PCA) are working in partnership with Paediatric Palliative Care Australia and New Zealand (PaPCANZ) on the Paediatric Palliative Care National Action Plan project which received grant funding from the Australian Government. 
We are establishing a diverse stakeholder engagement group to participate in consultation activities throughout the project. You are invited to complete this survey to register your expression of interest for consultation opportunities.
Your participation in this survey is completely voluntary. If you feel uncomfortable answering any questions you can withdraw from the survey at any point.
Survey participants should note that the information collected from the survey or other consultation activities will be used by PCA to inform the relevant projects under the three-year work plan of the Paediatric Palliative Care National Action Plan project.
The PCA privacy Policy is freely available on the PCA website at www.palliativecare.org.au

Please ensure that you provide your contact details if you are interested in participating in activities within the Project. 

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* 1. What is your profession ?

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* 2. What type of service do you work in?

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* 3. What state do you work in?

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* 4. What geographical area does your service cover?

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* 5. What hours do you work?

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* 6. Please indicate below which best describes your level of availability for participation

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* 7. Please indicate which best describes your preferred method of participation

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* 8. What additional skills set do you have ?

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* 9. What subjects are of particular interest to you?

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* 10. Please indicate the specific activities you would be interested in being part of the consultation group for?

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* 11. Tell us about yourself and your experience in Paediatric Palliative Care?

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* 12. Please indicate how you learnt about the Paediatric Palliative Care stakeholder expression of Interest survey

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* 13. If you are happy for members of the Project Team to contact you please provide your best contact details

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