Register for student placement

Registration of Interest

• First name *
• Last name *
• Email *
• Phone *
• Date of birth *At Cerebral Palsy Alliance we can only accept people in to programs who are over 16years of age.
• State of residence *Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
• Suburb of residence *
• Place of study *SchoolTAFEUniversityOther
• Textarea
  Please describe your place of study.
• Name of “above” Institute / school
• Current course / discipline
• Hours available / hours required *
• Specific placement requirements or expected outcomes from experience? *
• Please list your skills / strengths so we can accurately respond with appropriate opportunities *