Aged Care Governance - Training and support via the Rural, Remote and First Nations Aged Care Service Development Assistance Panel (SDAP) - Page 1 of 9 - Australian Government Department of Health, Disability and Ageing

Page 1 of 9

Introduction

1. Key contact name

Name (Required)

2. Key email contact

Email (Required)

3. Key phone contact

Phone

4. The role of the Key contact within the organisation

What is your role within the organisation? (Required)

5. Name of organisation

Organisation (Required)

6. Service Address

Service Location (Required)

7. Provider ID Number (if relevant)

(for existing providers – as listed on the Government Provider Management System (GPMS))

8. Provider Head Office Location - if different

Provider Head Office Location - if different