TRAIL Application Form

Thank you for providing your personal information so that we will be able to undertake a recruitment process for the TRAIL Leadership Program. Your data is collected in compliance with our data collection and privacy policies which can be found on our website. Your data will be shared with the personnel responsible for the recruitment of the program and will be stored if you are successful in gaining a place on the program. If you experience difficulty in completing this form, please feel free to contact us as we will be able to offer you assistance to complete the application form in alternative methods.

1. Personal Details

Name*

First Middle Last

Preferred Name*

Date of Birth*

Gender*

With which gender do you identify?

Please specify

Do you identify as Aboriginal or Torres Strait Islander?*

In which country were you born?*

Do you identify as any of the following?*

Please specify*

What is your first language?*

Do you speak any other languages?*

Yes
No

Please specify*

1.1. Contact Details

Mobile Number*

Work Number

Email*

Residential Address*

Address Line 1 Address Line 2 City State Postcode Country

Postal Address if different to residential

Same as Residential Address

Address Line 1 Address Line 2 City State Postcode Country

1.2. Publicity

How did you hear about the TRAIL Leadership Program?*

Please specify*

2. Industry and Community Involvement

Tell us about your employment, industry and community involvement and how it is supporting the agribusiness sector in rural, regional and remote Australia.

2.1. Current or most recent employment

Employment*

Please specify*

Sector*

Please specify*

Food Fibre and Forestry sub-sector*

Please specify*

Position*

Organisation*

Responsibilities*

Length of time in this position*

3. Leadership responsibilities and major achievements

Leadership responsibilities*

Briefly describe any leadership responsibilities in your work or community experience that you have undertaken. What valuable learning did you gain from your experience (s)?

Major achievements*

Briefly describe any major achievements associated with your industry or community experience (paid or unpaid). This can include awards or scholarships.

Community positions*

Please list any community positions you currently hold, length of term and responsibilities.

3.1. Leadership Programs

Have you completed any other leadership programs?

Leadership Program Name

Year Completed

Organisation

Other Leadership Programs

If you took part in any further Leadership Programs, please list them here.

3.2 Motivation and Background

Why do you want to undertake this leadership development program?*

What impact are you having now as a leader?*

What impact do you want to have on rural, regional and remote Australia as a result of your participation in this leadership development program?*

4. Education

Note: There are no prior education requirements needed to undertake this program, this information is collected for statistical purposes only

Education Level*

Educational Institution

Year completed

5. Referee Details

To support your application, the ARLF requires you to provide the contact details for two referees. Ideally this will be a professional referee and a personal referee. Please ensure you have asked their permission prior to submitting this application as the ARLF will contact them directly.

5.1. First Referee

First Referee Name*

Relationship*

Organisation*

Email*

Phone*

5.2. Second Referee

Second Referee Name*

Relationship*

Organisation*

Email*

Phone*

6. Health

General Health Assessment: Do you have any medical conditions/disabilities that could preclude you from any activities?*

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 ARLF can provide a safe learning environment for all and be able to meet its insurance requirements.

Yes
No

Please provide details

7. Agreement

Please read and indicate your agreement to the following terms.

7.1. I understand the cost of this Program is $10,450 (inclusive of GST)*

Yes

Please email the invoice to*

First Name Last Name

Email*

Phone*

7.2. I understand that I am required to make a participant contribution of $220 (inclusive of GST)*

Yes

7.3. I agree to commit to the residential components of this program and to make myself available for the duration of the program.*

Yes

7.4. I understand that my participation is confirmed only when full registration payment is made.*

Yes

7.5. I have read and agree to the Terms and Conditions.*

View short course registration TERMS AND CONDITIONS. There are fees and penalties associated with cancellations, transfers and substitutions, please read these Terms and Conditions thoroughly. Also, you can view the ARLF Privacy Policy here.

Yes

7.6. I declare that the information provided in this form is complete and correct.*

Yes

Following receipt of your registration, the ARLF will issue an invoice for payment. Further details will be sent to you regarding the Program and the participant information required

2021 TRAIL Application Form

1. Personal Details

1.1. Contact Details

1.2. Publicity

2. Industry and Community Involvement

2.1. Current or most recent employment

3. Leadership responsibilities and major achievements

3.1. Leadership Programs

3.2 Motivation and Background

4. Education

5. Referee Details

5.1. First Referee

5.2. Second Referee

6. Health

7. Agreement