Leaders for Geelong Program Application
PLEASE COMPLETE THE FORM USING FIREFOX OR CHROME WEB BROWSER To complete this application you will need to attach your CV and a supporting statement from your employer (unless self-nominating).
Applications close Monday 15 March 2021. Applicants will be shortlisted and interviewed in March 2021.
Offers will be made by 31 March 2021.
The form must be completed in one sitting. You cannot save the form to complete later. We recommend completing the application in Word and then copying and pasting into the form.
Organisation Contact Details
Female Male Non-binary Employment / Experiences
Leadership Development Questions
What Personal Leadership Learnings do you hope to gain from the Leaders for Geelong Program? *
What Organisational Leadership Learnings do you hope to gain from the Leaders for Geelong Program?*
What Community-based Leadership Learnings do you hope to gain from the Leaders for Geelong Program?*
How are you going to measure the success of your involvement in the Leaders for Geelong program?*
Do you have any further comments?:
LfG 2021/2022 commences April 2021 and concludes June 2022. As a guide, the time commitment and attendance includes:
2021 Opening Residential ( 2 days/1 night )
Day Seminars and Evening Workshops
Canberra Delegation ( 2 days/1 night )
Community Based Action Learning Project
Project Presentation Event
Closing Seminar & Lunch
Individuals or organisations with financial or economic barriers should not be discouraged from applying. Contact
on Victoria Strachan to discuss individual circumstances in confidence. 5227 8075 Cancellation/withdrawal from the program
All cancellations (and/or subsequent withdrawals from the program) must be advised in writing. Charges for cancellations and withdrawals will be applied, as stated below, to cover fixed cost commitments and administration fees. Cancellations received prior to the commencement of the program will incur a 10% cancellation fee. Please note that program places are non-transferrable.
Notification of withdrawal within 3 months of the program commencement will incur a 50% cancellation fee. No refunds will apply after this point as places cannot be offered to other candidates. Privacy
The Committee for Geelong are committed to protecting and respecting the privacy of its members, staff and participants by handling all personal information securely and with care in accordance with Australian privacy laws.
Your personal information is collected on this form for the purpose of your participation in the Leaders for Geelong Program. The Company may disclose your personal information kept on our database to third party organisations for the purpose of functions, events, programs and initiatives of the Company. If you would like to access your personal information held by us, or would like to withdraw your consent to share personal information at anytime, please contact the Leadership Portfolio Manager of the Committee for Geelong.
Declaration and Participant Agreement
I declare that the information supplied by me is true and correct. I understand the goals of the program and the time commitment required of a participant in the Leaders for Geelong program. If selected for the program:
I will devote the required time to attendance and personal involvement;
I agree that any information and photographs throughout the program may be used for promotion - including the Committee for Geelong leadership programs and associated websites;
I understand that Government COVID restrictions may result in rescheduledm, altered delivery method and/or cancelled events.
I consent to have my email address shared amongst participants
I understand that as a Leaders for Geelong alumni, beyond the program, I commit to increased involvement and leadership in the community.
I confirm that I understand and agree to the conditions outlined.
Applicant signature (Sign below with your mouse)*
Employer Agreement/Responsibility (or if self-nominating)
The candidate has my full support to participate in the next Leaders for Geelong program. I am aware of the time commitment, organisational and financial contribution.