Information provided in this form will be used to assess applications for funding and/or support from the VRGP.
Information provided will be disclosed to the Department of Health and other individuals, agencies or organisations (e.g. local health providers) as required by law or as deemed necessary by VRGP to fulfil its obligations in the administration of Rural Generalist Consolidation Program.
By completing this form you are indicating your permission for VRGP to use the information provided as described above. If you have any concerns, please contact VRGP Statewide Administrator.