Application form

Leadership WA’s Signature Leadership Program

1Welcome/Personal details

2Personal Details

3Education

4Employment and Experience

5Employment and Experience

6Activities and Affiliations

7Personal Leadership

8Personal Leadership

9Payment Details

PERSONAL DETAILS:
Would you like an Executive Assistant to be CC'd into your emails?*
- Yes
- No
Executive Assistant Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
DD slash MM slash YYYY
Gender*
- Female
- Male
- Non-binary
- Other
If other, please specify*
What do you identify as your cultural background?*
If multiple please separate with a comma (,)
Do you identify as Aboriginal Australian and/or Torres Strait Islander?*
- Yes
- No
Where did you hear about us?*
If other, please specify*
SOCIAL MEDIA:
LinkedIn URL

EMPLOYMENT AND EXPERIENCE
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Organisation is a
- Commercial Business
- Government Department
- Government Trading Enterprise
- Tertiary Institution
- Not-For-Profit Organisation
- Household
Current position title*
Work Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
SCHOLARSHIP
Please tell us about the financial situation of your organisation and the need for financial assistance or your personal financial hardship*
If you are successful and are offered a Scholarship please tell us how participation in the leadership program will benefit yourself, your organisation and enhance your capacity to make a positive impact on the community*
How is the organisation you work for/own aligned or involved in the grains industry?*
Please provide a brief description of current responsibilities and role within the business*
My reasons for applying for the Growing Leaders Scholarship Program are:*
My personal vision for the WA grain industry is:*
My personal vision for my career/business is:
Professional Profile (Biography)*
A few adjectives or phrases that describe me are:*
I have a good understanding of what my personal obligations are in participating in the Growing Leaders Scholarship Program, the associated Leadership WA’s Programs and community engagement expectations. I understand that I am required to cover all travel and accommodation costs associated with attending the program events and experiences.*
Does your role require you to travel or have periods of peak workloads? (e.g. harvest, seeding)*
- Yes
- No

Application form

Leadership Western Australia

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