Registration Form

1

Organisation Name

2

Name of Contact Person

3

Job title of Contact Person

4

Contact Number

5

Email

example@example.com

6

As an organisation we nominate the following staff to participate in the DIV projectIf you wish to nominate more participants, please email s.kelly@sev.org.au to discuss further

Name

Email

Name

Email

Name

Email

Name

Email

7

I will complete the surveys which are pre and post workshops

YESNO

8

I am willing to undertake a disability inclusive self-assessment of the organisation

YESNO

9

I agree to create and implement a Disability Action Plan for this organisation

YESNO

10

I agree to consider creating a Disability Inclusion Statement for this organisation

YESNO

11

I understand that when I discuss these workshops within my workplace, conversations may arise which are negative and I will need to address them

YESNO

12

I understand that procedural changes may be required as a result of these workshops, the self-assessment and the Disability Action Plan.These changes may require approval by others in the organisation

YESNO