RDA Victoria

Participant expression of interest

Submitting this expression of interest places the participant on the waiting list to be considered for an RDAV program. It does not guarantee a place. RDAV will contact you about assessment and availability at a suitable Centre.

Your details: person completing this form

Your first name

Your last name

Your email address

Your phone number

About the participant

Participant Name

Date of Birth

Street Address

Suburb

State

Postcode

Your preferences

First-choice Centre

Other Centres you would consider (up to two)

TEST Centre SouthTEST Centre North

Availability for each day (morning and afternoon)

Before choosing days and times, please check the operating days and hours of your preferred Centre. Centres do not all operate on the same days or at the same times.

I would like the RDAV newsletter

YesNo

I acknowledge that RDAV will use this information to assess and respond to this enquiry.

YesNo

* required

Your answers save as you go

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Participant expression of interest

Your details: person completing this form

Who you are completing this form for

About the participant

Preferences and support

Your preferences