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Welfare champion | Expression of interest
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Email
*
Your email
Full name
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Your answer
Date of birth
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(Please note American formatting)
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DD
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YYYY
Gender
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Female
Male
Prefer not to say
Other:
Contact number
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Your answer
State
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Choose
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Suburb
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Your answer
Which mental health profession do you identify with?
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Your answer
Which body/organisation are you registered with and at what level?
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Your answer
In 100 words or less, why would you like to get involved with Outside the Locker Room?
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Your answer
Have you played team sports or been involved in a sporting club before? If not, please answer "N/A".
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Your answer
Have you worked or volunteered for your community and/or sporting club before? Which club/community?
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Your answer
Have you facilitated or delivered psycho-education training before? If yes, please elaborate.
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Your answer
How far are you prepared to travel? Please answer in hours or kilometers.
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Your answer
Most of our sessions run on week nights (6-9pm). Please indicate your availability.
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Monday daytime
Monday evenings
Tuesday daytime
Tuesday evenings
Wednesday daytime
Wednesday evenings
Thursday daytime
Thursday evenings
Friday daytime
Friday evenings
Weekends
Required
Do you have an ABN?
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Yes
No
Do you have your own professional indemnity and public liability insurance?
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Yes
No
Do you have a Working with Children Check?
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Yes
No
Would a police check disclose anything that could impact your ability to carry out your role as a welfare champion, e.g. IVOs?
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Yes
No
Have you ever had any ethical or criminal complaints made against you?
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Yes
No
How did you first find out about this opportunity to become a welfare champion?
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A professional registration body (e.g. ACA, APS, PACFA)
Our Facebook
Our Instagram
Our website
Search engine
Word of mouth
Other:
By clicking 'YES', you accept that you MUST sign all relevant contractual agreements before you can become an Outside the Locker Room welfare champion.
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No
I have read and accept Outside the Locker Room's privacy policy.
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https://bit.ly/otlr-privacy
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Send me a copy of my responses.
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