Australian Rural Leadership Program Course 29 Application Form

Thank you for providing your personal information so that we will be able to undertake a recruitment process for the Australian Rural 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*

2. 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

3. Publicity

How did you hear about the Australian Rural Leadership Program?*

Please specify*

Have you applied to undertake the Australian Rural Leadership Program before?*

Yes
No

Which year or course?*

4. Current or most recent employment

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

Employment*

Sector*

Position*

Organisation*

Responsibilities*

5. Leadership responsibilities

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)?

Community positions*

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

6. Leadership Programs and Further Learning

Have you completed any other leadership programs or further learning opportunities in the last 12 months?*

If yes, please provide details*

7. Motivation, Impact and Contribution

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

What impact would you like to have as a leader to contribute to rural, regional and remote Australia?*

If successful, you will be awarded a $50,000 scholarship to participate in the program. Please explain why you should be awarded this scholarship?*

What does diversity mean to you? In what way will you contribute to the diversity of Course 29 of ARLP?*

Please outline an idea for a project initiative you have that would contribute to your community, workplace, industry or region. What is your project idea? What is the need for your project? Who will it assist and how? What will the impact be for rural Australia? What role would you play in leading this project or contributing to it?*

8. Education

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

Education Level*

9. Video

We invite you to create a short video to support your application. This is optional and will not effect the outcome of your application. Videos must be no longer than 2 minutes and uploaded to the link below as either an mp4 or mov file. Please save it using the following naming convention: lastname-firstname-C29video. For tips on how to create your video click here.

Upload your video here.

You will be taken to a new window where you will need to click upload to ensure your file is successfully received.

Did you upload a video?

Yes
No

10. John B. Foundation Innovation in Agriculture Scholarship

Do you work in the Agriculture sector and would you like to be considered for this scholarship?

The John B. Foundation Innovation in Agriculture Scholarship is open to ARLP Course 29 applicants from the agriculture sector. The scholarship will fund the successful applicant’s participation in ARLP C29. After graduating from the program, the scholarship recipient will be funded to undertake an overseas study tour to further explore and enhance their contribution to innovation in Australian agriculture. For more information click here.

This will not preclude you from being considered for other scholarships.

Yes
No

11. Referee Details

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

Referee

Referee Name*

Relationship*

Organisation*

Email*

Phone*

12. 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

13. Agreement

Please read and indicate your agreement to the following terms.

The ARLP requires 50 days over a 15-month period. This includes approximately 46 face to face and 4 online. Are you able to commit to all dates as outlined on our information page?**

Yes
No

Do you agree to abide by all ARLF policies and procedures as outlined in ARLF handbooks, policies, procedures and contracts?*

Yes
No

Have you advised your family and employer that this program requires participants to be away for extended periods of time?*

Yes
No

As part of your commitment to the program, are you willing to engage with your sponsor to provide input, written reports and/or presentations as required?*

Yes
No

If you are selected to participate in the ARLP you are required to contribute $5,500.00 (including GST) personally towards the cost of participation. This personal contribution is tax-deductible as a self-education expense. This can be paid in instalments as negotiated with the ARLF. Do you agree to undertake this requirement?*

Yes
No

I allow the ARLF to use the information in my application for the purposes of selection for the ARLP. This may include forwarding the information to a third party or potential sponsor*

You can view the ARLF Privacy Policy and Collection Notice here.

Yes

I undertake to publicise and promote my positive experiences with the ARLP throughout the course of the program and into the future, when I can. I understand I may be required to engage with media as a part of the program curriculum*

Yes
No

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

Yes