Your information

First Name *

Last Name *

Email Address *

Mobile *

Postal Address *

We collect the following information to understand who is applying to our programs as part of our work to deliver inclusive programs for our community. Only PCT programs staff can see these responses.

Do you identify as Aboriginal or Torres Strait Islander? *

YesNo

Are you an Australian citizen or permanent resident? *

YesNo

Gender (optional):

How will your Program fees be covered? *

My employer or other organisation is sponsoring my participationI will self-fundI would like to be considered for available scholarships

Please attach a letter from your organisation confirming acknowledgement of the terms and conditions, that they will pay the program fee (if you are selected), and providing a name and contact details for contract/invoice purposes *

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Terms and conditions available at: https://www.petercullentrust.org.au/wp-content/uploads/2024/06/Terms-and-Conditions-PCT-Leadership-Program_20240627.pdf

Employment Information

Current employer *

Duration with this employer

Your position title *

Duration in this position

Employer address: *

Supervisor's Name *

Supervisor's Email *

Referees (two are required)

Referee 1 Name

Referee 1 Mobile / Tel

Referee 1 Organisation

Referee 1 Email

Referee 2 Name

Referee 2 Mobile / Tel

Referee 2 Organisation

Referee 2 Email

Application Materials

Please submit your application materials below:

A. Your current CV

B. A written statement of claims addressing the selection criteria:

Willingness and ongoing commitment to
personal learning.
Desire to make a positive impact as proactive
leaders at work and in community.
Ability to think strategically in a big picture context.
Previous leadership experience, style and reflections.
Evidence of leading change though collaboration.

C. Your pitch of why you are the right match for this Program. Why you, and why now? What do you hope to change as a result of the program?

We welcome you to submit your pitch in a format that suits you:

(i) A video of no more than 2 minutes, OR
(ii) Audio of no more than 2 minutes, OR
(iii) Written material of no more than 500 words, OR
(iv) other equivalent presentation we haven’t thought of (go on, surprise us!)

Your current CV *

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A written statement of claims addressing the selection criteria *

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Your pitch (If you have a document or audio pitch upload it here):

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Your pitch (If you have a video pitch please put the YouTube link here):

Authorisation

By checking this box, I accept the Terms and Conditions, authorise the verification of the information provided on this form regarding my employment, and give permission for my referees to be contacted. *

Signature *

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Date of submission

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Accepted?

YesNo

Participant Information

We collect the following information so we can make travel and accommodation bookings for you, and to help us with preparation for the Program:

Name as it appears on identification documents: *

Date of birth: *

Dietary requirements: *

Access requirements or other needs:

Please briefly describe any cultural awareness training and/or experience you have: