A one day Advanced Workshop

Cancer Council NSW 153 Dowling Street Woolloomooloo

Wednesday 18 May 2016

9:30 am – 4:30 pm

Registration & Pre-Workshop Survey
This workshop is intended for experienced leaders who have already attended the General Cancer SupportGroup Leader Training run by Cancer Council NSW or another recognised Leader Training or Professional Experience, and/or have experienced grief and loss in their support group.
Have you completed Cancer Support Group Leader Training at
Cancer Council NSW? / YesNo
If you have not trained with Cancer Council NSW, please provide details of other Leader Training or Professional Experience:
Have you experienced grief and loss in your support group? / Yes No
If you have experienced grief or loss in your group, please provide outline of the situation:
Can you commit to attend the full training day? (9.30am – 4.30pm) / Yes No

If you have answered NO to any of the above questions please contact Sally on02 9334 1846 to discuss further. Answering NO does not necessarily exclude you from this workshop.

Cost of Attending the Workshop
Whilst there is no charge for you to attend the Workshop, each place is valued at approximately $500. This amount includes expenses such as facilitator costs, resources and catering but excludes travel and accommodation.
As a community funded organisation we have a responsibility to those who donate their money to spend our funds wisely, so we would be grateful if you could carefully consider your availability to attend and once registered, notify us immediately if you are no longer able to attend so we can allocate your place to another person.
Title / First name / Last name
Address / Suburb / Postcode
Phone: Work / Home / Mobile
Email: Work / Home
Support Group Name
Regional Cancer Council Office: Please tick the office you have affiliation with:
Metropolitan Sydney (Woolloomooloo) / Central Coast Community Office (Erina)
Northern Regional Office (Byron Bay) / Greater Western Sydney Regional Office (Parramatta)
Hunter Regional Office (Newcastle) / Northern Community Office (Coffs Harbour)
Northern Regional Office (Tamworth) / Western Regional Office (Wagga Wagga)
Southern Regional Office (Wollongong) / Western Regional Office (Orange)
Does your regional Cancer Council Office know that you are interested in attending Leader Training? / Yes No
Travel and Accommodation Assistance
Rural and regional Cancer Support Group Leaders may be eligible to receive travel and/or accommodation assistance from their regional Cancer Council office to attend this workshop.
Do you require Travel/Accommodation Assistance to attend this workshop? / Yes No
If YES: Which level of assistance is required: / Travel onlyAccommodation onlyBoth
Dietary Requirements
No special requirementsVegetarianVeganGluten Free
Pre-Workshop Survey
  1. General experience in leading a Support Group(please select one):

New / 3 months / 6 months / 12 months / over 12 months
  1. Which best describes your involvement in the Support Group (please select all that apply)

Community Peer LeaderCarerHad a cancer diagnosisHealth professional
  1. How confident are you in leading a support group where issues of loss and change arise?
Scale: (1) being not at all confident and (5) being very confident
1 / 2 / 3 / 4 / 5
Pre-Workshop Survey continued…
  1. What is your level of need, for the following issues, as a leader of a cancer support group?
Scale: (1) being no need and (5) being high need
a)Bereavement and pre-bereavement support techniques:
1 / 2 / 3 / 4 / 5
b)Grief support techniques:
1 / 2 / 3 / 4 / 5
c)Loss and how to manage group reactions:
1 / 2 / 3 / 4 / 5
d)Changing dynamics in support groups following loss of members:
1 / 2 / 3 / 4 / 5
  1. What kind of losses do you find most confronting in the group setting?

  1. Do you have a background in the health sciences?
/ Yes No
If yes, what is your professional background (social worker, nurse, psychologist, etc)?
  1. What areas of knowledge/skill do you already have in the area of grief, loss and change?

  1. Are there any other topics, issues or areas of interest you would like included in the workshop?

  1. What might get in the way of your learning at this workshop (eg personal bereavement)?

  1. What would you like to leave the workshop knowing more about?

  1. Do you have any other comments that would be useful for the trainer to know?

Thank you for taking the time to complete this form.

Please post, fax or email your completed form to:

Sally Carveth, Assistance Coordinator, Cancer Support Group Leader Program

Cancer Council NSW
PO Box 572
Kings Cross NSW 1340 / Fax:
02 8302 3520 / Email: