Online Focussed Psychological Strategies Skills Training Course Scholarship Application Form

Last updated 26 April 2024

For more information on this scholarship opportunity, the requirements of the workshop and the Terms and Conditions, you can view the Online Focussed Psychological Strategies Skills Training Scholarship page .

* denotes required field

First name:

Last name:

RACGP ID:

Email:

Mobile number:

Clinic name:

Clinic address:

Clinic suburb:

Modified Monash Model (MMM) area:

Find the MMM area here

Are you employed a minimum 8 hours per week in the private practice or non-state government primary health sector?:

YesNo

I agree with the terms & conditions:

I agree with the terms & conditions as outlined above

I agree for the RACGP to share my details:

I agree for Royal Australian College of General Practitioners (RACGP) to share my professional details with the Rural Workforce Agency of Victoria (RWAV)

Declaration:

I declare that this application form has been completed independently by me and the information provided is accurate at the time submission.

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