Dementia Knowledge to Action Program Expression of Interest

Thank you for your interest in the Dementia Knowledge to Action Program. This program is designed to turn your dementia knowledge into real, impactful changes in care practices. Please complete the following Expression of Interest (EOI) form to begin your application process.

Are you a decision-maker in your organisation?*

Yes

Please be advised that a decision-maker needs to be involved in the future conversations with DTA.

Name*

First Last

Role*

Please state the name of your current role at your organisation

Qualifications

Please briefly describe your qualifications related to aged care, dementia care, or healthcare.

Experience

Please briefly describe your experience of working with people with dementia.

Contact Email*

Contact Phone Number*

Please exclude country code from number (+61)

Organisation Name*

Organisation Type (Care Setting)*

Primary Work Address*

Street Address Suburb State ZIP / Postal Code Country

Decision Maker*

Please enter the name of the decision maker/manager who will support this application

Decision Maker Position*

Please enter the position of the decision maker who will support this application

Decision Maker Contact Email*

Please provide a valid email address for correspondence with decision maker/manager

Decision Maker Contact Phone*

Please exclude country code from number (+61)

How did you find out about DTA?*

DTA Website

Previous contact with DTA

Dementia Support Australia (DSA) representative

Marketing Campaign

Other

Other*

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