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Name*

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Type of Enquiry*

• Training Advice – You would like to ask about our training courses or consultancies • Technical Support – Course extensions, login issues, certificate issues or website issues • Feedback – You would like to give a compliment, make a complaint or provide general feedback • Other – any other type of enquiry

Is this enquiry about training for yourself or your team?*

Is this enquiry for yourself as an individual or your team at your organisation or facility?

Organisation Name*

The name of the company that owns the business / facility you work at – e.g. IRT, Bupa, NSW Health. If this is for you personally, please enter Individual.

Facility Name*

The name of the Residential Aged Care Facility that this training would be for. If this is for you personally, please enter Individual. If there are several, please enter Multiple.

Facility Address

Please enter the address of the facility this enquiry relates to (your facility address for multiple facilities).

Australian State / Territory or Overseas*

Please enter the State or Territory where your facility or you are based. If you are based outside of Australia, please select Outside Australia.

Suburb*

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How did you find out about DTA?*

How did you find out about DTA – Other Details

How can we help you with dementia training?*

Briefly describe the training need you are seeking to fill, the outcomes you wish to achieve or how else we can assist you with dementia training.

What is the issue that you need assistance with?*

Briefly describe the technical issue you are experiencing – e.g. “I am having difficulty creating an account on the website”, “I can’t access my course certificate for Course Name”, “I need the details for the Course Name that I am attending in a few days time”. Please include the Course Name you are having difficulty with and any other details you feel are important.

Topic*

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Would you like us to contact you?*

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