Application form Leadership WA’s Signature Leadership Program 1Welcome/Personal details2Personal Details3Education 4Employment and Experience5Employment and Experience6Activities and Affiliations7Personal Leadership8Personal Leadership9Payment Details Thank you for your interest in applying for the Leadership WA Signature Leadership Program. Selection to the Program is a competitive process and includes an online application and an interview. All applicants are assessed by a selection panel, and you will be advised of the outcome of your application when the full process has been completed and the 2025 cohort curated. This will be in late, 2024. We recommend you hold all 2025 Program dates in your calendar, in anticipation of a successful outcome. As part of the selection process, we aim to bring together participants from a diverse range of backgrounds, industries, occupations and experience. This is to ensure the cohort has a wide diversity of thought and perspectives, for a more rewarding experience for all participants. A limited number of full or partial Scholarships are available, thanks to the generosity of donors to the Leadership WA Foundation and our Scholarship partners. Your assessment of suitability for the Signature Leadership Program is not affected by your request for Scholarship support, which is considered separately. As such, we suggest candidates investigate the possibility of alternative funding support, ahead of the Program offers, should you be successful for a place on the Program but without the offer of a Scholarship place (as we always receive more applications than available Scholarships). WHEN APPLYING, PLEASE NOTE: • All applications are confidential. • All questions need to be completed in full and the declaration signed. • Individuals may nominate themselves, however, employed applicants must have the full support of their employer to participate (both from a funding and attendance perspective). If you are self-employed, you can support your own application. • You are requested to upload a current headshot (as jpeg/png) and resume (as PDF file) as part of your application. We suggest a LinkedIn-style headshot and one that you will be happy to have shared with your fellow participants, which we will do at the Opening Retreat. Files must be uploaded prior to submitting the form. (NB: File sizes must not exceed 400kb) • You can save and continue your application by clicking the link at the bottom of the page. A unique link will be sent to your email. (If you haven’t received your link, please check your spam folder and, if it is not there, let us know). If you are applying for a Scholarship, please ensure you meet all the eligibility requirements of your nominated Scholarship, which can be found at www.leadershipwa.org.au/scholarships. There are clear requirements around organisation type and income levels. If you have any questions in relation to your application, at any stage of the process, please contact Danni Wick at Signature@leadershipwa.org.au or on (08) 6381 6700. Thank You. We wish you all the best and look forward to supporting you on your leadership journey. This field is hidden when viewing the formprogramThe Growing Leaderships Scholarship Program is open to any applicants who are involved in a grain growing enterprise in WA, are based regionally, and have demonstrated grower group involvement as well as community interest and/or leadership.PERSONAL DETAILS:Title*TitleMrMissMsMrsDrAssociate ProfessorProfessorName* First Last Email* This is how we will keep in touch with you, please note that the email address you choose must remain the same, at least until you submit your full application to ensure we receive it. Phone*Work Phone (optional)Name of organisation you are employed by*Are you applying for a Scholarship? Yes No Scholarship Applications for 2025 have now closed.Scholarship Information The Growing Leaders Scholarship is only open to members of the Western Australian grain growing industry. The Leadership WA Foundation Scholarships are available for those working in small-medium* not-for-profit organisation with an annual income below $20 million or a small business or sole trader. The LeadAbility Scholarship is available for people with lived experience of disability, or those who work in the sector The Leadership in Culture and the Arts Scholarship is open to senior leaders who are employed by a small-medium Western Australian not-for-profit organisation/association with an annual income of less than $20 million, or a small business, actively working for the betterment of the culture and the arts sector in WA. The Leadership in Sport and Recreation Scholarship is open to senior leaders who are employed by a small-medium Western Australian not-for-profit organisation/association, with an annual income of less than $20 million, or a small business, actively working for the betterment of the sport and recreation sector in WA. The Leadership in the Culturally and Linguistically Diverse (CaLD) Communities Scholarship is open to senior leaders who are employed by a small-medium Western Australian not-for-profit organisation/association, with an annual income of less than $20 million, or a small business, actively working for the betterment of culturally and linguistically diverse communities (CaLD) in WA. This field is hidden when viewing the formWhich Scholarship do you wish to apply for?* Growing Leaders Scholarship Leadership WA Foundation Scholarship LeadAbility Scholarship Leadership in Culture and the Arts Scholarship Leadership in Sport and Recreation Scholarship Leadership in the Culturally and Linguistically Diverse (CaLD) Communities This field is hidden when viewing the formHow did you hear about the Growing Leaders Scholarship Program?* Direct from GGA Direct from CBH Past Scholarship Recipient Social Media Word of Mouth Print Media You may select more than one of the aboveWe highly recommend saving your Application at this point. The form can take 30 minutes plus to complete and by saving now you’ll be able to come back and complete the Application with additional information as needed. 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 CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* DD slash MM slash YYYY Gender* Female Male 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?*ColleagueManagerSearch engineAlumni eventFacebookLinkedInOtherIf other, please specify*SOCIAL MEDIA:LinkedIn URLProfessional Facebook URLProfessional Twitter URL EDUCATIONAre you currently studying?* Yes No I have checked the dates of the Program and am confident my formal study will not affect my participation in the Signature Leadership Program.* Yes Due to the commitment required for our programs it is not recommended to be engaged in formal study while on a program with Leadership WA. However, participants may be able to accommodate both. We recommend you check the dates of the program and make sure your formal study workload will not lessen your ability to fully participate in the program. If you would like to speak to the Leadership Development Manager about this, please call us on (08) 6381 6700.Please enter the details of your current study below.*Highest level of education*Doctoral degreeMaster's degreePost Graduate Certificate/DiplomaBachelor's DegreeAssociate DegreeAdvanced DiplomaDiplomaCertificateHigh School GraduateDid Not GraduateInstitutionYear completed/expected completionPlease enter a number from 1950 to 2050.Please enter your hobbies and interests. Gardening Baking Journaling Fencing Theatre Yoga Languages Boardgames Creating and organising a book club Networking events Local meetups Volunteering at a charity centre Public speaking Exploring other cultures Dancing Camping Playing a musical instrument Reading Writing Sketching Photography Design Blog writing Painting Football Volleyball Marathon running Skiing Tennis Cycling Swimming Baseball Mountain climbing Other If other, please specify*SKILLSPlease list (multiple choice) your skills.* Administration & Office Support Advertising & Media Agriculture Audit and Risk Banking & Financial Services Board Experience Call Centre & Customer Service Coaching/Mentoring Communications/PR/Marketing Community Engagement Community Services Construction Consulting & Strategy Creative/Performing Arts Data Design & Architecture Digital/Cybersecurity Education & Training Engineering Environment & Conservation Event Management Finance & Accounting Fundraising/Sponsorship & Grants General Management Governance Government & Defence Healthcare & Medical Hospitality & Tourism Human Resources Industrial Relations IT/Information & Communication Technology Insurance Legal Manufacturing Mining/Resources & Energy Occupational Safety and Health Organisational Development Policy and Legislation Project Management Real Estate & Property Retail & Consumer Products Sales Science & Technology Small/Own Business Management Sport & Recreation Stakeholder Engagement Strategic Planning Tendering Trades & Services Transport & Logistics Other (please specify below) If other, please specify.* EMPLOYMENT AND EXPERIENCEOrganisation is a* Commercial Business Government Department Not-For-Profit Organisation Sole Trader Current position title*Work Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country SCHOLARSHIPPlease describe your current leadership role in actively working in or for the betterment of the culture and the arts sector in Western Australia*(max 250 words)Please describe your current leadership role in actively working in or for the betterment of the sport and recreation sector in Western Australia*(max 250 words)Please describe your current leadership role in actively working in or for the betterment of the culturally and linguistically diverse (CaLD) community in Western Australia*(max 250 words)How do you feel your participation in the Signature Program will enhance your ability to support the sector?*(max 250 words)How do you practically intend on taking your leadership learnings back to your sector?*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) – this can be provided as an attachment if necessary*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.*YesNoDoes your role require you to travel or have periods of peak workloads? (e.g. harvest, seeding)* Yes No EMPLOYMENT AND EXPERIENCELine Manager's Name* First Last Line Manager's Title*Line Manager's Email* Line Manager's Phone*What do you consider your highest or most significant career achievement to date?* ACTIVITIES AND AFFILIATIONSPlease list up to five community, civic, professional, business, religious, social, sports and other organisations of which you are, or have been, a member or volunteer indicating any positions of responsibility.*How much time each month do you currently commit to the above organisations or equivalent activities?*What kind of community activities would you like to get into in the future?* PERSONAL LEADERSHIPWhy are you applying for the Signature Leadership Program?*Describe your leadership style/s. (approx 250 words)*Tell us about your values. (approx 250 words)*Describe your personal inspirations, leader/s or role model/s and why they are important to you. (approx 250 words)*Please outline any leadership training/courses/subjects you have completed via studies, employment or voluntary work.*What strengths and experiences do you feel you would bring to the Program and your fellow participants?*Please outline your understanding of experiential learning.* PERSONAL LEADERSHIPThe Leadership WA community has significant potential to lead transformational social change in our world. We would be very interested to know more about the role/s you have in the community. What impact have you made?*We are interested in finding out more about two key community issues you believe are facing Western Australia. The issues you select could be challenges to be addressed and/or opportunities to be realised. What are the two issues and why do you feel they are important? (approx 250 words)*What do you feel needs to be done on the challenges identified above? (approx 250 words)*How will the broader WA community benefit from your successful completion of the Program?*How will your organisation benefit from your successful completion of the Program?*Upload Headshot* Drop files here or Select files Accepted file types: jpg, png, , Max. file size: 128 MB, Max. files: 1. This can be a similar style to a photo you use for your LinkedIn profile i.e., does not need to be a professional headshot.Upload Resume* Drop files here or Select files Accepted file types: pdf, Max. file size: 128 MB, Max. files: 1. PAYMENTHave you discussed payment with your employer?* Yes No Please select how payment will be made* My employer will pay I will be paying *please note we are referring to the "employer contribution" portion on the payment. Please note scholarships are only available to applicants from not-for-profit organisations.Name of company/person to be invoiced.*I have read and understood the privacy policy and the terms and conditions of Leadership WA.* Agree If unsuccessful I would like Leadership WA to contact me about other opportunities. Yes No Terms & conditions Privacy Policy Code of ConductNameThis field is for validation purposes and should be left unchanged.