Scholarships for Aboriginal & Torres Strait Islander Focused Workers Form

Name*
First Last
Email address*
Enter Email Confirm Email
Phone number*

Please provide your mobile number to be contacted regarding this scholarship
Workplace Name*
Workplace Location*
What is your current role?*
Which SHINE SA course would you like to attend (including course date)?*
What are your reasons for wanting to do this course?*
If you are registered with AHPRA, please provide your AHPRA number:
If you are applying for a contribution towards expenses incurred to attend the course please outline the support required and why, including estimated costs:
Any other comments: