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FPS Scholarship EOI form

Page last updated 13 November 2025

Submit an expression of interest

* All fields are required

Name:*

Email:*

RACGP ID:*

Modified Monash Model (MMM) area:*

Name of Practice:*

Suburb or town of practice:*

I have completed MHST Level 1 (please advise date completed):*

I have completed MHST Level 2 (please advise date completed):*

I currently use FPS in my practice (please advise number of cases):*

Preferred intake:*

Declaration:*

I declare that:

I agree

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