Emerging Leader Application Form

Name *

Address *

Email Address *

Tell us a little about yourself. Who you are? Where you come from? *

What is it like living in your community? *

What are your hopes for the future? For your family/community/work? *

Who recognises and encourages your leadership? *

Referee 1 *

Organisation *

Phone Number *

Reference Letter

Referee 2 *

Organisation *

Phone Number *

Reference Letter

Referee 3 *

Organisation *

Phone Number *

Reference Letter

In approximately 200 words tell us why you are applying for this Emerging Leader Award, which one you are applying for, what or who prompted you to take this step and what it would enable you to achieve that you otherwise wouldn’t be able to?

What is your vision for the Aboriginal and Torres Strait Islander community in Victoria? Share your vision for a better future for Aboriginal and Torres Strait Islander Victorians.

Who do you admire as a leader who is working towards the achievement of this vision?

Provide an outline of a 12 month plan to be implemented in your local community, sector or statewide that has a specific vision or idea. The plan should include any development of personal and professional skills, specific aims, activities that will help you achieve your objectives, draft timeline and proposed budget.

How will you assist your community and how will you know that it has been effective?

Give details of your track record and achievements to date working to bring about positive change in Victoria’s Aboriginal and Torres Strait Islander community or having an impact on the non-Aboriginal and Torres Strait Islander community. Tell us briefly about your personal and professional experience.

Who else would be involved in your work? Are there other people/organisations with whom you need to create relationships to achieve your objectives? What kind of support would you need in your work as part of the Emerging Leader Program?

Document #1:

Document #2:

Document #3:

Additional Notes: