Add Program/Service

* Program:(title of program/activity. Use a name which describes the area the program covers eg Gold Coast COPMI)
 *Required

 

* Contact Names:  *Required

 

Name of Organisation:

 

 

* Address Details: *Required

 

 

* Post Code: *Required

 

* State: Select a State ACT NSW SA TAS VIC WA QLD  *Required

 

Telephone:(please include area code) 

 

Mobile Phone: 

 

Email :

 

Fax:(please include area code):

 

Web Address: (include full address)

 

 

* Program/Activity Description: *Required

 

 

 

* Program Evaluation Information (type of evaluation being used or planned or enter 'none') *Required

 

 

 

* Evidence on which program is based (eg clinical experience, research (describe and give references if possible or enter 'none') *Required

 

 

 

* Any other information you wish to add or please enter 'none' *Required

 

 

 

 

* Region: State National International  *Required

Please go over the program details that you have added to check the accuracy of the information. If you are satisfied, check the 'Information Accurate' box, and then click the 'Submit' button. By clicking the Submit button you are also agreeing for your information to be placed on the COPMI Website.

Thank you for updating our database of programs and services. Your information will be uploaded to our website.

* Information Accurate Yes  *Required

*As an anti-spam measure, please type the word 'submit' in the field below:
 *Required

Children of Parents with a Mental Illness national initiative
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022

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No unauthorised duplication of materials permitted without consent.
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