PLEASE NOTE ALL INFORMATION WITHIN IS CONFIDENTIAL AND PROTECTED, IF YOU QUALIFY FOR A FULLY FUNDED POSITION YOU WILL BE NOTIFIED FOR CONSENT PRIOR IF THE FUNDING BODY REQUIRES ANY INFORMATION. Name(Required) First Last Your Date Of Birth(Required) Day Month Year Your Phone Number(Required) Your Email(Required) Address(Required) Street Address City State ZIP / Postal Code Next of Kin Name?(Required) Next Of Kins Phone Number?(Required)Choose one of the following (there is no right or wrong answers, you ALL qualify):(Required) Currently Serving Currently Serving in the Process of Discharging Ex-Serving What date did you discharge? Day Month Year Who do/did you serve with?(Required) Army Navy Airforce HiddenAre you a current serving ADF member in the process of discharging from service and receiving mental health treatment? Yes No Were you medically retired from service?(Required) Yes No HiddenHave you been discharged from the ADF within the last two to five years? Yes No HiddenHave you been discharged from the ADF within the last two to five years and you are receiving mental health treatment? Yes No Current Occupation (if "unemployed", do you receive a DVA pension?)(Required) Have you been diagnosed with a mental health condition?(Required) Yes No Do you have a treating clinician (psychologist, psychiatrist, counsellor etc)?(Required) Yes No What are some of your goals on the STTN program?(Required) Personal Development Success Coaching Improve Mental Health Improve Physical Health Improve Relationships Find my Purpose Rediscover my Identity Peer Support/Community Financial Confidence Transitioning Success Select AllHow Important is it for you to complete this program and achieve your goals? (Scale 1 to 10)(Required)12345678910As you will be sponsored onto the program, you MUST complete the course. How committed are you?(Required) Committed Need Support Interested Just here for the mates STTN is no substitute for clinical health professionals, we ask all participants to please seek out a clinical professional for diagnosis and treatment. If you are in a crisis we ask you to please call Open Arms Veterans and Families Counselling 24hr number on 1800 011 046 or in an emergency 000 (please do not use the peer support page), do you understand and will you follow this procedure?(Required) Yes No HiddenIf you are currently discharging or have discharged up to 5 years from the ADF and you are receiving mental health treatment does your treating clinician give you permission to enroll on the STTN program? (If not yet, that's ok, we can still get you on the course). Yes No Congratulations You Have Qualified! Please answer these final questions below.The following questions ask how satisfied you feel, on a scale from zero to 10. Zero means you feel no satisfaction at all and 10 means you feel completely satisfied.Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole ?(Required)12345678910How satisfied are you with your standard of living?(Required)12345678910How satisfied are you with your health?(Required)12345678910How satisfied are you with what you are achieving in life?(Required)12345678910How satisfied are you with your personal relationships?(Required)12345678910How satisfied are you with how safe you feel?(Required)12345678910How satisfied are you with feeling part of your community?(Required)12345678910How satisfied are you with your future security?(Required)12345678910At completion of your program, would you like to be offered the opportunity to become an STTN peer mentor?(Required) Yes No You Agree To Our T&Cs(Required) I agree 1.Welcome to http://survivetothrivenation.com/ post-war-survive-to-thrive-program. 1.1 The Post-war-survive-to-thrive-program is a web based self-help program owned and operated by Survive to Thrive Nation Pty Ltd. It is intended to help you play an active role in managing your own PTSD symptoms and assist you on your recovery journey. 1.2 If you need technical assistance with your course you can contact us on +61 1300 557 637 between 9am 5pm AEST Monday to Friday (excluding public holidays) or email us from the Online program 2. Warning 2.1 If you require urgent medical attention or you are at risk of harming yourself or someone else or where any doubt exists regarding the selection or appropriateness of any therapy described on this Online program, you must immediately seek specific advice from a qualified healthcare professional. 2.2 If you decide to enrol in a Post-war –survive-to-thrive self-help course, you must agree to the following: a) You work through the course in order from the first to the last module b) You progress at a self-paced manner. c) The Survive to Thrive Self Help program is not a substitute for professional help. *These courses were not designed for crisis management. If you are in distress we advise you to speak to a doctor or mental health professional. c) If you are feeling suicidal or need to talk to someone phone Lifeline Australia on 13 11 14, or an alternate crisis centre with the same specialty. 3. Acknowledgment and Acceptance 3.1. The Online program provides an internet based service operated by Survive to Thrive Nation Pty Ltd ("we","our" or "us"). "You" or "your" means a user of the Online program including any parent or guardian of any minor or other person lacking capacity. 3.2. If you do not agree with any of these terms, do not use the Online program. 3.3 By clicking “I accept”, you agree to be personally bound by these terms of use, either for yourself or for a minor on whose behalf you are registering. 3.4. Please refer to these terms periodically as they are subject to change without notice. 4. Permitted Use and Restrictions on Use 4.1. Subject to filling out the registration form you may use the Online program for your personal and non-commercial use. 4.2. You must ensure that the Online program is protected from unauthorised access by third parties at all times. 4.3. You may not transfer your rights to use the Online program. 4.4. You may not, in any form, or by any means: a) copy, reproduce, store, transmit, publish, modify, create a deriv- ative work from, reverse engineer, reverse assemble or otherwise create derivative works from any part of the online program or its contents. b) cause any of the Online program to be framed or embedded in another online program; c) commercialise any content, products or services in the Online program; or d) distribute any portion of the Online program to any third party or make the Online program available to any third party in any way other than in a manner specifically authorised under these terms. 5. Intellectual property rights 5.1. All rights (including intellectual property rights such as copyright and trade mark) now existing or in future arising in the Online program and its content is owned by or licensed to Survive to Thrive Nation Pty Ltd. 5.2. You do not obtain any rights in the Online program other than the user rights granted in this agreement. 6. Privacy and Information Provided by You 6.1. By accessing the Online program you agree to be bound by these terms and to our collection, use and disclosure of any personal information that you provide to Survive to Thrive Nation Pty Ltd in connection to the Online program, provided that such collection, use and disclosure is in accordance with our Privacy Policy. 6.2. We collect, use and disclose all your information in accordance with our Privacy Policy. 6.3. These terms incorporate the Privacy Policy. 6.4. The Online program may also contain information or material which is posted by you or other Online program users (User Provided Content). For all User Provided Content, we are a distributor only and we are not responsible for the accuracy or completeness of this information. 6.5. If you submit User Provided Content to the Online program: a) you acknowledge that the content will be considered non- confidential and non-sensitive; b). you grant us a perpetual, irrevocable licence to use, host and distribute the User Provided Content; c) you acknowledge that it may be seen and used by others under the licence described in these terms; d) we may send you correspondence related to that content; and e) you must only submit User Provided Content which belongs to you or for which you have authorization to submit from the owner of that content. 6.6. You must not contribute (and we may remove in our sole discretion) any User Provided Content that is in our opinion fraudul ent, abusive, illegal, obscene, indecent, defamatory, incites racial or ethnic hatred or violates the rights of others or is in any other way objectionable. 7. Disclaimer and Limitation of Liability 7.1. At all times you should consult a qualified healthcare professional. 7.2 The services are provided in good faith and on an „as is‟ basis. 7.3. To the extent permitted by law, we make no guarantee that the services we provide: a) are suitable for your needs; b) are error free; c) can be used without interruption or will be timely; d) will be accurate, effective, reliable or complete; or e) are free of viruses, worms, bugs or similar components or is secure. 7.4 Without limiting 7.2, where law prohibits us from excluding or modifying our liability under a certain condition or warranty, the liability under that condition or warranty will be limited to the re-supply of services. 7.5. If links are provided to other Internet sites they are provided for your convenience only. We do not endorse the content of those sites and have no control over the content of those sites. 7.6. If you are sponsored onto the STTN Program on behalf of Queensland RSL and are seeing a clinical professional you acknowledge that you must have permission by your treating clinician to enrol onto the program. 8. Your obligations 8.1. You are responsible for: a) maintaining the confidentiality and security of your email address and password; and b) all usage or activity that occurs on your account (whether authorised or unauthorised). 8.2. You must promptly notify us if there is any unauthorised usage of your account 8.3. We will not be responsible for any losses arising out of the unauthorised use of your account. 8.4 You must ensure that your account is accurate and up-to-date. You may update, edit or terminate your account at any time. 8.5 Your responsibilities include: a) Completing lessons 1 and 2 in the first 30 days b) Completing all lessons of the course within 60 days c) Reflecting on the course material and do the suggested activities between lessons d) Contacting your clinician for additional support if required. 9 Termination Cancellation by Us 9.1. We may: a) cease offering to provide services; or b) by notice to you, terminate accounts; at our sole discretion at any time. 9.2. We may terminate your access to the Online program without notice to you if you fail to comply with any provision of this agreement. 9.3. Upon termination by us by written notice to you, you must immediately cease to use the Online program. 9.4. Without limiting the operation of any other term, we will not be held liable for loss or damage arising from the exercising of these rights. Cancellation by You 9.5. You may cease using the service at anytime. Survival 9.6. Upon the termination of this agreement, the clauses relating to intellectual property, disclaimer, and limitation of liability and restrictions of use remain in force. 10. Applicable Law 10.1. These terms are governed by and must be construed in accordance with the laws of Queensland, Australia and you irrevocably and unconditionally submit to the non- exclusive jurisdiction of the courts of Queensland, Australia and all courts which have jurisdiction to hear appeals from those courts.
