Dementia Knowledge to Action Program: Rural and Remote Edition - Expression of Interest Form

Before you fill out this form, please make sure you or your staff member meet the minimum eligibility criteria to participate in this program:

Working frontline (or with staff working at the front line of care) in residential, community aged care or multi-purpose services in Australia (this program is not suitable for acute or primary care workers).
Knowledgeable about dementia and have at least 2 years of experience in supporting people living with dementia.
For individuals: Have support from management to complete all program requirements during work hours. You need to provide the name and contact information of your manager.
Currently working in a rural or remote location, as defined by the 2023 Modified Monash Model geographical classification system. Eligible classifications are MMM3 – MMM7. You can check your eligibility here.

If you do not meet the eligibility please consider our other program options that may be suitable for you.

To be contacted by our team, you need to fill out all the required information fields.

Are you completing this form for:*

Yourself (you are an employee)

Your staff (you are a manager)

Organisation Name*

Organisation Type (Care Setting)*

Primary Work Address*

Street Address Suburb State ZIP / Postal Code Country

Decision Maker*

Please enter the name of the decision maker/manager who will support this application

Decision Maker Position*

Please enter the position of the decision maker/manager who will support this application

Decision Maker Contact Email*

Please provide a valid email address for correspondence with decision maker/manager

Decision Maker Contact Phone*

Please exclude country code from number (+61)

How did you find out about DTA?*

Other*

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Dementia Knowledge to Action Program: Rural and Remote Edition – Expression of Interest Form

Before you fill out this form, please make sure you or your staff member meet the minimum eligibility criteria to participate in this program: