PARTICIPANT APPLICATION FORM, Regional Queensland - Word on the Street

Thank you for your interest in Upbeat Arts Queensland. To apply to be a member of one of our online Regional Queensland creative writing programs, please complete this form. On receipt of your application, we'll check eligibility and availability of your program and be in touch with you via email.


Word on the Street Online members will need a referral from either Queensland Health, the agency they are working with or being supported by, or a medical professional to confirm a mental health diagnosis, or a letter from your GP to indicate the program would benefit your mental health. Ideally, you must reside within or near to the region you are applying for. IE Wide Bay, Central Queensland, Sunshine Coast, Mackay or Darling Downs. However, feel free to check with us about availability for your area if within Queensland.
The referral body information is included in this form - no other forms are required.

A little about you


Regional Program Choice

For our records

Referrer Details

Emergency Contact Details


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