Fillable Example Only - ARLP COURSE 27 APPLICATION FORM (Social Security and Welfare; Other Economic Affairs Culture)

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Example Only - ARLP COURSE 27 APPLICATION FORM (Social Security and Welfare; Other Economic Affairs Culture)

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For office use only
Name
Registration No.
AUSTRALIAN RURAL
LEADERSHIP PROGRAM
Course 27
APPLICATION FORM
The closing date for applications is 30 August 2019
1. To be eligible to apply for the
leadership course through TSRA you
must be:
- Indigenous and living in the Torres
Strait Region
- Determined to succeed and
committed to the full program
2. The completed application form
should be emailed to
info@tsra.gov.au. Please include a
full-colour passport size
photograph of yourself.
3. If you require support or assistance to
complete the application form or do not
have internet access, please contact the
Torres Strait Regional Authority.
4. If you have further questions please contact
the Torres Strait Regional Authority on:
: 07 4069 0700
: 07 4069 1879
: info@tsra.gov.au
: www.tsra.gov.au
Checklist:
1. Complete the application (Word or PDF) and enclose your photo (jpeg format)
2. Make certain your referees are notified of your application
3. Send your application and photo to info@tsra.gov.au
4. Upload a video to support your application (optional)
For infromation about what to include in your video, see Upload your video
Australian Rural Leadership Program
Information for Applicants for Course 27 - August 2020 to October 2021
The Australian Rural Leadership Program (ARLP) is an education program for people
who are leaders and want to support a resilient rural, regional and remote Australia.
Individuals who undertake the program work collaboratively within industries, supply
chains, communities and other rural and regional service sectors.
The program offers challenging experiences to support leadership development in three
key learning areas:
personal effectiveness;
ethics, values, social responsibility and an appreciation of diversity; and
thinking, conceptual and analytical skills.
Pre-requisites
There are no prior formal education requirements. Applicants must:
demonstrate leadership within rural, regional or remote Australia;
want to help build a resilient remote, rural and regional Australia;
have the capacity and commitment to lead within their community, industry or
sector;
make the commitment to attend all sessions of the program and complete all
requirements; and
contribute to and draw upon the Foundation’s Network of Fellows.
Timing of selection, scholarship offers and course sessions
Selection is competitive. Following the short-listing of applicants, the Foundation
conducts interviews in regional locations in November - December 2019. Decision on the
allocation of scholarships is usually finalised by December 2019.
Residential sessions comprising more than 50 days of face-to-face learning, are held
between:
July/August 2020 (Darwin, NT and Kimberley, WA)
November 2020 (Location to be advised)
February 2021 (Location to be advised)
May/June 2021 (Vietnam)
October 2021 (Canberra, ACT)
Accreditation
The Australian Rural Leadership Program is accredited by James Cook University (JCU) at
graduate certificate level and participants can choose to enroll in this option.
Costs
The bulk of the Program costs will be met through a scholarship that will be funded by a
sponsor. If you are selected for the Program, you will be required to contribute $5,500
towards the cost of your participation (which may be paid in installments upon
negotiation).
While the costs of travel and accommodation will be met from the scholarship, you will
need to cover transport costs between your home and an agreed regional airport when
travelling to and from sessions. You will also need to meet minor costs associated with your
participation in the Program, such as occasional meals, taxis and personal incidentals.
1. Contact details
1a. Your full name:
1aa. Your Skype address/’name’:
1b. Preferred name:
1c. Title (Ms, Mr):
1d. Date of birth:
1e. Male
Female
1f. Mobile:
1g. Email:
1h. Home address:
1i. Postal address (if different from above):
1j. Home phone number:
1k. Where were you born?
1l. Where were your parents
born?
1m. Work phone number:
1n. Are you of Aboriginal or Torres Strait Islander descent? Yes
No
2. Your motivation and background
2a. Where did you first hear about the Australian Rural Leadership Program?
A program graduate
Media: TV Radio Print Online
A person in your industry/community
Other (please specify)
2b. Why do you want to undertake this leadership development program?
2c. What do you expect to gain from your involvement in the program?
2d. Describe the characteristics you think are required to be an effective leader in your context?
2e. What is your vision for rural, regional or remote Australia in five years time?
2f. What industry or community leadership aspirations do you have or what roles do you aspire to?
(Please be specific):
In 3-5 years
In 10 years
3. Your involvement
3a. What is your current main role/work?
3b. Name of your employer(s)
3c. What sort of work do you do currently?
Describe your responsibilities, and if you work
part-time, identify any other work that you
undertake (paid or unpaid).
3d. How long have you worked in this position
or with this employer? And if you have been
working in the role for a short time, what were
you doing before this role?
3e. If you are involved in primary production,
list the commodities you produce currently and
provide some background to the scale of
production.
3f. Provide a brief overview of your work and community involvement
Industry
Organisation:
Position held:
From/To:
Community (including paid and unpaid)
Organisation:
Position held:
From/To:
3g. Please describe any of your major achievements associated with your industry or community (paid
and unpaid). This can include awards or scholarships.
4. Education and other relevant experience
Note: There are no prior education requirements needed to undertake the program.
4a. Formal education
Highest level obtained:
Name of educational
institution:
Years:
Qualification:
4b. Other relevant courses or training:
4c. Have you applied to undertake
the Australian Rural Leadership
Program before?
Yes
No
When?
4d. Have you undertaken any other
leadership programs in the past?
Yes
No
When?
Name of program:
4e. Briefly describe any leadership responsibilities that you have undertaken. What valuable learning did
you gain from your experience(s)?
5. Australian Rural Leadership Foundation requirements
5a. The ARLP requires more than 50 face-to-face contact days over a 17-month period
(see www.rural-leaders.com.au for details). Are you able to attend all sessions,
including an Overseas Study Tour of two weeks duration?
Yes
No
5b. Have you advised your family and employer that this will require you to be away for
extended periods of time?
Yes
No
5c. The Foundation requires that all participants complete a mid-term report and final
report to their sponsor. Please indicate that you will undertake this requirement as part
of successful completion of the program.
Yes
No
5d. As part of your commitment to your sponsor, are you willing to contact the sponsor
and provide feedback when required?
Yes
No
5e. If you are selected to participate in the ARLP you are required to contribute
$5,500 personally towards the cost of participation. This personal
contribution is tax-deductible as a self-education expense. This can be paid in
installments as negotiated with the Foundation. Do you agree to undertake this
requirement?
Yes
No
5f. Health (In the event that full disclosure is not made; the participant may be asked to leave the
program). Applicants must disclose the nature and extent of any illness or disability to ensure that the
Foundation can provide a safe learning environment for all and be able to meet its insurance
requirements. General health assessment: Do you have any medical conditions/disabilities that could
preclude you from any activities? Please provide details.
5g. Please provide the following details about your two referees:
Referees
Industry/organisation referee
Second referee
Name/Job title:
Organisation/business:
Email:
Telephone:
6. Declaration
I declare that the information provided in this form is complete and correct.
Applicant’s signature:
Date:
Employer’s signature (if applicable ):
Date:
Please email your application to info@tsra.gov.au. Save the application as a Word document OR a PDF and save
your passport sized photo as a jpeg file. It is up to you to make certain that your application and photo arrive at the
TSRA office successfully and on time. You can contact the office on 07 4069 0700.
Thank you for your interest in developing leadership in rural, regional and remote Australia.
Australian Rural Leadership Foundation Limited ACN 056 874 767 ABN 80 056 874 767
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Example Only - ARLP COURSE 27 APPLICATION FORM (Social Security and Welfare; Other Economic Affairs Culture)

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Completed 18 July 2020

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