Pathways to Resilience Trust Application Form – Individuals

Your Name (required)

Name of school / organisation:

Position

Address

Address 2

State
QLDNSWVICSANTTASWAACT
Post Code

Phone

Fax

Your Email (required)

Please provide a brief summary of your role and why you wish to receive this training:

Background: Does the community you serve identify with any of the following?
 Non-English Speaking Background Disability Aboriginal / Torres Strait Islander Isolated / Rural Socio-economically disadvantaged Drought affected area Culturally and linguistically diverse
Other


Do you currently run any similar programs (e.g. resilience or social skills programs)?
 Yes No

If Yes, which program(s)?


How do you intend to use the training e.g. implement the program within your school, to inform wider school community/organisation about the programs etc?

Which program(s) would you like to be trained in and what are your preferred training dates (see News and Events on our website)?
 Fun Friends (4-7 years) Preferred dates:

 FRIENDS for Life (Child: 7-12 years) Preferred dates:

 FRIENDS for Life (Youth: 12 – 17 years) Preferred dates:

Do you wish to order morning tea and lunch for the training day? (cost is $15 per head for muffins, fruit and sandwiches).  Yes No

Would you like to: Make payment on the day (cash or eftpos) Invoice school/organisation?

Do you have any special dietary requirements? Yes No
Please specify

Why do you think your community would benefit from these programs?


Questions/comments?


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