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 availability of your program and be in touch with you via email.


Word on the Street Online members will need to be referred by either Queensland Health, the agency or service they are working with or being supported by, or a medical professional. 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

If you are applying for a community member place in a session, please type 'community' in the 'Name of Referrer' space, and n/a in both the 'Organisation Name and Phone No' spaces below.

Emergency Contact Details


Thank you for completing this form. Please look out for your Welcome Email, which will arrive within two business days. You may need to look in your junk/spam folder for an email from Please add this email to your safe senders list.
You will be sent a link to each weekly session on the email address supplied here - please ensure you monitor this email the day prior to each session.

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