Recognising and Responding to Sexual Violence in Adults - CPD Training Enrolment

Palmerston Hospital

Admissions form

Please complete this form to commence the admissions process to enrol into this training.  

Please note that spaces are limited and completing this admissions process does not guarantee enrolment into the training units.

This training is fully funded by the Commonwealth Department of Social Services under the National Plan to End Violence Against Women and Children 2022-2032.

Enrolment Intake

Please select which CPD unit you are interested in participating in. (tick all that apply)
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Face-to-face - Unit 3: Responding to Sexual Violence in At-Risk Patients (Palmerston Hospital)
25 Sep 2024 - 25 Sep 2024 Face-to-face
16 places available

AHPRA Details

This application is designed for AHPRA registered professionals. If you are not a member of AHPRA, we encourage you to apply for the VET course hosted by RMIT at: VET RMIT application page.

AHPRA Registration Number
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Personal Details

Please complete all required fields below

Surname
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First Name
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Contact Mobile Number
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Email Address (personal emails are preferred)
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Indigenous Status
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How do you describe your gender? Gender refers to current gender, which may be different to sex recorded at birth and may be different to what is indicated on legal documents.
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Please advise if you have any dietary requirements
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Practice Details

Please complete all required fields below

Primary Organisation
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[Work] Address -
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[Work] Work Address
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[Work] Work Address
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[Work] Address - Street Address 1
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[Work] Address - Street Address 2
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[Work] Unit/Flat Number
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[Work] Street/Lot number
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[Work] Street Name
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[Work] Suburb
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[Work] Address - Overseas State/Province
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[Work] State
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[Work] Post Code
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[Work] Country
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What is your practice setting?
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What is your profession?
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Medical College and/or Professional Association membership. Please provide the membership number for the Medical College selected. If you select other, please list the College details here too.
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Select your area of Practice
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Does your practice include any of the listed patient groups? (tick all that apply)
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Please indicate your work area/department
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Statement of Motivation

Street Number
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Street Name
Entity Data - Address - Home - Street Address 2|These fields have been deprecated as they didn't properly feed the address information. Please use the newly added fields: Unit/Flat Number, Street/Lot Number and Street Name.
Please insert a statement of motivation (no more than 300 words) which addresses your reasons for undertaking this course, relevant experience, how this training will affect your practice or enhance patient well-being, any other factors such as patient mix which may be relevant and any anticipated barriers (unstable internet connection, workload etc.,) in completing the course and how you would manage these.

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Marketing

In order to assist us with marketing this valuable training, we would appreciate it if you could complete the question below.
How did you hear about this CPD training?
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If Other, please write your response below.
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Subscription Details

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