2025 Red Earth Community Leadership Program Application

Age:

Under 30

30-45

46-59

60+

What is your gender?

Male

Female

Prefer not to disclose

Do you identify as Aboriginal or Torres Strait Islander?

Yes

Prefer not to disclose

Do you identify as a person with a disability or impairment?

Yes

Prefer not to disclose

If YES is selected, please indicate the type of disabiltity or impairment

Emergency Contact Name:

Emergency Contact Phone Number:

Dietary Requirements:

Yes

Please give details of your dietary requirements if any

Please give details of any special needs

There are limited spaces available in the program. Your answers will assist the panel in the selection process. This program is open to anyone interested in enhancing leadership skills, whether you hold a formal leadership role

1. Why are you interested in the Red Earth Community Leadership program?

2. Describe your current industry, business, or life activity?

3. What is your role in this business or activity?

4. How are you involved in improving your industry, community, or environment?

5. What are your personal hopes for your industry or community?

6. What do you hope to gain from participating in this program?

7. Do you have previous experience in leadership roles or development programs? If yes, please provide details.

8. What is the highest level of formal education you've achieved?

1. From your perspective, what are the 3 most important challenges facing your region?

2. What are 3 opportunities for the region you live in?

3. How could you contribute to developing these opportunites?

Employer (if applicable):

I have the full support of my employer to participate in the Red Earth Community Leadership Program, and they are aware of the time commitment involved. They are happy to be contacted to confirm.

Employer Name

Title/Position

Contact Email:

Contact Phone Number:

Personal Recommendations:
Please list two people other than your employer / sponsor who are knowledgeable about your leadership performance and/or potential.

Name:

Email Address:

Phone Number:

Name:

Email Address:

Phone Number:

The total cost of the program is $2900.00, inclusive of GST. Upon acceptance, participants are required to pay a non-refundable deposit of $290.00. The balance of $2610.00 is due by 10 January 2025.

A limited number of scholarships are available annually for candidates who do not have access to a sponsoring organisation.

Please select one of the following:

My sponsor/employer will fund the $2610.00 portion, and will pay the $290.00 deposit.

My sponsor/employer will partially fund an agreed amount. I will pay the remaining balance.

I will personally fund the full $2900.00

I need to discuss financial assistance options

Cancellation Policy:

Cancellation after 10 January 2025 and prior to one week before the program begins: A refund of $2610.00 may be issued if a replacement participant is found.
Cancellation within 7 days of the program start: No refund will be issued.

* Please note all amounts in this form are inclusive of GST.

Please select...

Direct Debit

Cheque

Direct Debit

BSB: 638-060. Account: 14764490 Name: Red Earth Community Foundation South Burnett

Cheque payable to Red Earth Community Foundation South Burnett

I commit to attending all 6 days and 4 nights of the program and actively contributing to its success.

I acknowledge the need to organise my own travel arrangements. If accepted, I understand that the $290.00 deposit is non-refundable.

Yes

Application Deadline: Sunday, 27 October 2024

Thank you for your application!

For further information, contact Kimberley at 0409 593 124 or via email at leadership@redearth.org.au