Please note all your information is kept private and confidential.
Thank you for applying for the Peer Mentoring Program.
Please answer all questions below truthfully and accurately, if you have any questions feel free to contact Rachael Duck on (03) 9994 0354 ext 214 or send her an email with subject Peer Mentoring Program at Rachael.firstname.lastname@example.org.
Please have the following information with you before starting this registration form:
The contact details (including phone and email) for your GP, mental health clinician and personal support person
Keep in mind that:
- All fields marked with an asterisk (*) on the application are required.
- You must click the 'Submit' button at the end to send your application to our PMP team for consideration.
At this time, you have to finish the application in one sitting. If you leave the form idle for more than 20 minutes, your session will expire, and you will have to start over!