Title:

Full legal name (as shown on your photo ID):

Age:

Gender:

Cultural identification:

Mobile Number:

E-mail address:

Residential Address:

Eligibility criteria
I confirm that I;

am an Australian citizen or permanent resident.

have lived experience of mental illness (as a consumer or carer), relevant to the focus of the forum, towards eliminating seclusion and restraint in mental health care.

have financial constraints which prevent me from attending the symposium without a bursary.

am aged 18 years or older.

am aged under 18 years but will be accompanied by a parent/guardian (note: any parent/guardian escorting an under 18-year-old delegate will attend at their own expense).

if under 18 years of age, I have my parents/guardian’s permission to apply for this bursary and attend the symposium. Please include a letter of permission from your parent/guardian.

I am applying as a;

CarerConsumer

In 200 words or less, please explain why you wish to attend the symposium:

In 200 words or less, please explain how you will share your learnings following the symposium:

Δ