DV-alert 1-Day Men who use Violence: DEVONPORT - Paranaple Convention Centre, CSELIF07156

This form requires a Unique Student Identifier (USI). Click here to find yours or set one up in just a few minutes.

Have you completed and gained competency in either
1. DV-alert 2-Day workshop (prior to July 2023) OR
2. DV-alert eLearning (General or Working with Women with Disabilities) OR
3. Foundations 2-Day OR
4. First Nations 2-Day?

Yes No Not yet completed Not yet issued

Completion date

To be eligible for this workshop you must have completed a 2-Day Accredited workshop (prior to 1^st July 2023), Accredited eLearning, or completed a Foundations 2-Day or First Nations 2-Day.

Click here for a list of available workshops.

Title

First name

First name (not preferred name)

Last name

Family name (surname)

Email address

Password

Confirm password

Birth date

Gender

Mobile number

Phone number: (home/work)

Address

Unique Student Identifier (USI)

Are you Aboriginal and/or Torres Strait Islander?

Which country were you born in?

What is the main language you speak at home?

How well do you speak English?

This form requires a Unique Student Identifier (USI). Click here to find yours or set one up in just a few minutes.

Which answer best describes your current employment status?

What is your primary occupation or volunteer role?

The course is designed for health, allied health or community frontline workers to apply.
If you are unsure of your Occupation category, please view our Occupation category guide.

If 'Other' please enter.

If you have selected 'other' for your Occupation.

Organisation: What is the name of the organisation you work for?

Must be spelt out and should be within the health, allied health, education, childcare and community sectors.

Organisation location: What is the location of where you work?

Suburb then State (example: Sydney, NSW)

Do you have any dietary requirements?

Do you have any participatory requirements?

How did you hear about us?

I declare that the information I have provided is true and correct to the best of my knowledge.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.

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DV-alert 1-day Men Who Use Violence Focused Workshop

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Student declaration and consent

DV-alert 1-day Men Who Use Violence Focused Workshop

TIME

VENUE

IMPORTANT