Full Name
Please include preferred title
Email
Contact Number
Board Registration Number
PsyBA Number (PSY----)
Residential Address
Area and Postcode (i.e., Longreach, 4730)
Main Working / Practice Address
This is where you work the majority of your weekly hours. Area and Postcode (i.e., Mount Isa, 4825)
Please list all other locations you work in or provide a service to in MMM3-7 (telehealth not included)
This will be regions you provide an in-person service to. Telehealth is not included. Area and Postcode (i.e., Mackay, 4740)
Do you work in any other services? Please select any that apply *
This field is required
Do you identify as any of the following? *
This field is required
Tell us how you found out about our program
This field is required
Tell us how you found out about our program
JCU Murtupuni (Western QLD)
JCU CRRH (Central QLD)
AAPi
Southern QLD Rural Health
Department of Education Western Australia
A QLD Hospital and Health Service (for example Mackay HHS)
Word of Mouth
Social Media
Other
Please list the main partner who told you about our program.
Bursary Application
You may also be eligible for a bursary for your time away from work while you're attending the Masterclass or Part 2 workshop. Bursaries are paid on the successful completion of the course you are funded for. For Masterclasses this is after you have successfully completed all the components of your Masterclass. For Full Training this is after you have successfully completed all three parts of your training and received your final certificate.
Eligibility will be based on the following criteria:
“Qualified psychologists providing health care in Queensland in private practice, a non-government, or not-for-profit organisation within an MMM 3-7 location, or an Aboriginal Health Service in an MMM 1-7 location, for at least 1 day [.2] per week.”
If you believe you are eligible for a bursary, please complete confirmation below and download the attached form at the bottom of the page. Your form will need to be emailed to supervisortraining@jcu.edu.au. We will let you know of the outcome of your application for a bursary within four weeks of your application.
Confirmation
Please review your answers for accuracy and completeness. By clicking on the submit button below you are confirming that all details you have provided are true and correct. We will be giving priority to psychologists who live in or service MM3-7 regions in-person for at least 50% of their work. You may be asked to provide evidence of your work in MM3-7 regions if you are in a MM1-2 region and have stated you service MM3-7 regions for more than 50% of your work.
