ACCF HPV and Me Program
School Registration Form

Thank you for your interest in the Australian Cervical Cancer Foundation’s HPV and Me school education program. The program provides age-appropriate education about HPV, HPV vaccination and cervical cancer prevention.

Please complete this short registration form, so we can understand who is using the program.  

This form collects school and staff contact information only. Please do not include student names, individual student health information or vaccination records.

Estimated completion time: 5 minutes.

Section 1: School details
School Type
School Sector
Region, network or diocese, if applicable
School website URL
Section 2: Main school contact
Main Contact Person
Main Contact Role
Main Contact Email address
Main Contact Phone Number
Preferred contact method
Principal name
Principal email address
Section 3: Program registration details
Has your school previously participated in the HPV and Me program?
How did you hear about our program?
Please provide the year level of the students you'd like to use the program. Please select...
Approximately how many students do you plan to deliver the course to? Please select...
Which formats of our presentations do you plan to use?
Section 4: Privacy and acknowledgement

The OAIC says organisations collecting personal information should take reasonable steps to notify people about matters such as who is collecting the information, why it is being collected, usual disclosures and privacy policy information. 

Privacy collection notice

The Australian Cervical Cancer Foundation collects the information in this form to respond to your school’s interest in the HPV and Me program, plan program delivery, provide relevant resources and communicate with your nominated school contact.

Please do not include student names, individual health information, vaccination records or other sensitive personal information in this form.

Information submitted through this form will be used by ACCF staff and authorised representatives for program planning, communication, reporting and evaluation purposes. ACCF will handle information in accordance with its privacy obligations and privacy policy. For privacy questions, please contact ACCF at: Helen.Boocock@accf.org.au.

I confirm that I am authorised to submit this registration of interest on behalf of the school.
I understand ACCF may use the information provided to contact the school about the HPV and Me program.
I understand that this form should not include student names, student health information or vaccination records.
Section 5: Can we contact you and feedback
We'd love to work with you to improve our resources. Would we be able to contact you for feedback please?
Would you like to receive updates about ACCF school resources and cervical cancer prevention education?

Australian Cervical Cancer Foundation - ABN 14 128 546 850
PO BOX 1008 Fortitude Valley Qld 4006