Confidential Application for 2014 Program

Please return your COMPLETED signed and scanned application form to:Amanda Hennessy, Executive Officerinfo@leadershipgreatsouthcoast.org.au

In addition to your electronic application please mail three signed hard copies of the completed application form to: Amanda Hennessy, Executive OfficerLeadership Great South CoastPO Box 51, Port Fairy, VIC 3284

This form can either be completed by hand, as a word document (which can then be printed, scanned and emailed) or as a PDF form (which can then be printed and emailed). Please note: You can only use the PDF Form (to be emailed) if you have the program Acrobat Professional. If you require assistance to complete the form, please contact LGSC Executive Officer Amanda Hennessy on 0408 627 066.

NOTE: typed forms are preferred

Application and Selection ProcessPlaces in the Leadership Great South Coast Program are limited. To ensure high quality participants from diverse backgrounds the selection process is robust and transparent.

Stage 1– Written ApplicationStage 2 – ShortlistingStage 3 – Interview ProcessStage 4 – Offers madeNOTE participants will be chosen on merit and their overall fit with the group.

Application Timelines 22 July 2013 - 2014 Program Application Open 25 September 2013 First Round Applications Close

NOTE Scholarship applicants are advised to submit applications in the First round.

11 October 2013 Second Round Applications Close October 2013 Shortlisting November 2013 Interviews scheduled December 2013 Offers Made

1

Selection CriteriaSelection criteria include:

Proven leadership record or aspirations with potential for further growth Potential to contribute significantly to the Great South Coast community Potential to progress to senior positions in industry, business, community organisations,

academia or government Ability to commit the required time and energy to the program and to engage as an active

learner

Instructions and Advice for Applicants1. The selection panel use the criteria in the application form. 2. Please read and complete the application form carefully.3. Complete each section in full, type all responses or print clearly.4. Limit answers to available space.5. Note no other documents will be accepted.6. Applications must be signed by the applicant and the sponsor/employer (where applicable).7. Short listed applicants will be interviewed by the selection panel in October / November. 8. The selection panel will be made up of members of the LGSC Committee.9. Applicants must have full support of the organisation they represent.10. Individuals may nominate themselves.11. All applications are subject to a confidential evaluation.12. The selection panel reserves the right to request certified copies of qualifications listed on

your application.13. Attendance at the Opening and Closing Retreats and participation in community projects

is mandatory. 14. Applicants must be able to attend 80% of the scheduled Program Days to graduate from

the Program.15. Each annual intake will have a balance of gender, location, public/private sector,

profit/non-profit participants. 16. The LGSC Program is committed to the selection of participants from across the Great South

Coast Region.17. Offers for the annual program will be made in December.18. The annual Program will commence in February and end in December.19. Program fees must be paid prior to commencing the Program unless otherwise arranged with

the Executive Officer.20. The % of fees paid by an employer and participant can be negotiated. LGSC will not be involved

in these negotiations.21. A range of scholarships will be offered annually, please refer to the LGSC website for details.

2

Personal DataFirst Name:

Middle Name:

Surname:

Preferred Name (Name Tags etc):

Date of Birth:

Male Female

Present Employer/Organisation:

Present Title/Position:

Date Commenced:

Business Address:

Business Postal Address:

City/Town: Postcode:

Business Email

Phone (BH): Mobile:

Home Address:

City/Town: Postcode:

Personal Mobile: Home Phone:

Preferred contact information

Preferred Email contact:

Preferred Mobile contact:

3

Employment / ExperiencePlease provide a brief description of your current role and responsibilities.

Does your current position require you to be out of the Great South Coast Region? Yes No

If so approx. how many days per month? Days

Previous Employment in chronological order

Employer Title / Responsibility

Dates

From To

1.

2.

3.

4.

What do you consider your proudest professional achievement to date?

4

EducationInstitution City Years Qualifications

From To

1.

2.

3.

4.

Please outline any extra-curricular activities / leadership activities during your education

5

Education Cont.List leadership training courses/units you have completed via your study, your employment or through volunteer work.

Will you be enrolled in any formal/accredited training next year? If yes please specify.

6

Community Activity and VolunteerismWhat are your main community interests?

Please list in order of importance, up to five community, civic, professional, business, religious, social, sports or other organisations of which you are (or have been) a member. Please advise any positions of responsibility held in the organisations.

Organisation Date of Membership Involvement and time commitment

1.

2.

3.

4.

5.

What kinds of volunteer activities would you like to pursue In the future?

7

Community AwarenessWhat are the two most exciting opportunities available to the Great South Coast region?

What do you feel are the two most significant issues facing the Great South Coast region?

What do you feel needs to be done to address/develop one of these?

8

PersonalWhat are your reasons for nominating for the Leadership Great South Coast Program?

What strengths and experiences do you bring to the Leadership Great South Coast Program?

What do you expect your employer will gain from your successful completion of the Leadership Great

South Coast Program?

What do you hope you and your community will gain from your participation in the Leadership Great

South Coast Program?

9

Personal Cont.Who is an inspirational leader or role model who inspires you and why?

Please describe yourself in a few phrases.

How did you find out about the Leadership Great South Coast Program? Please highlight one of the

options below:

Via Employer

Newspaper

Radio

Print media

Other (please specify):

10

ReferencesPlease list two (2) persons other than your employer/sponsor who are knowledgeable about your leadership performance and potential.

Name:

Organisation: Title:

Phone:

Name:

Organisation: Title:

Phone:

Participant Commitment Leadership Great South Coast is a one year Program commencing February and concluding December.

Graduation from the Leadership Great South Coast Program requires attendance of a minimum of 80% of Program Days. Opening and Closing retreats and project participation is mandatory.

Program BreakdownOpening Retreat (Friday/Saturday) – compulsory

Average of 2 Program Days per month (which may include tours) commencing at approximately 9am and concluding around 4.30pm (min 80% attendance required). Lunch included.Council meeting tour outside scheduled Program Days

Day trip to Victorian Parliament

Commencement of a project completed at times agreed by the group (within the Program timelines) – compulsory

Closing Retreat (Friday/Saturday) – compulsory

11

Financial ContributionsParticipants and their organisations are asked to contribute to Leadership Great South Coast in order to offset the costs of running the Program. The contribution amounts are set at $3000 + GST (total $3300) per participant.

Program fees must be paid prior to commencing the Program unless otherwise arranged with the Executive Officer.

The % of fees paid by an employer and participant can be negotiated. LGSC will not be involved in these negotiations.

Statement of Employer supportThis candidate has my full support to participate in the Leadership Great South Coast Program.

I am fully aware of the time commitment and organisational financial commitment associated with this Program

My organisation is fully aware of the time commitment and organisational financial commitment associated with this Program.

Employer or Sponsor Name:

Title:

Signature:

Date:

Personal CommitmentI understand the goals and time commitments of the Leadership Great South Coast Program. If selected, I will devote the required time and pay the personal contribution upon request.

I understand that I am committing myself to increased community involvement upon graduation and ongoing connection to Leadership Great South Coast through the alumni program.

If selected I agree that any Information and photographs taken throughout the Program may be used for Program promotion and media releases including the LGSC and associated websites.

Applicant Name:

Signature: Date:

12

ScholarshipsThe Leadership Great South Coast Committee is committed to the selection of participants with diverse backgrounds, and also to the principle that no economic barrier should prevent any suitable individual or organisation from participating in the leadership program.

Should the Program fee ($3000 + GST) pose a difficulty the Chair of the LGSC Committee would be pleased to discuss the circumstances confidentially. Every effort will be made to find scholarships to ensure a diverse range of participants although no guarantee can be given that this will be successful.

Leadership Great South Coast makes a number of scholarships available annually. Please refer to the website for more information.

Scholarship criteria are set by scholarship sponsors in discussion with LGSC.

The LGSC selection panel will select participants who best meet the set criteria while ensuring each annual intake has a balance of gender, location, public/private sector, profit/non-profit participants.

Please indicate if you wish to apply for a scholarship place.

Yes No

Please provide the selection panel with your motivation for this scholarship application.

PRIOR TO SUBMITTING YOUR APPLICATION PLEASE CHECK THAT YOU HAVE:1. Completed all sections in full2. Provided your preferred email and mobile contact info3. Your employer has signed the application 4. You have signed and dated your application

PLEASE NOTE: To see our full sponsor list please visit our website:www.leadershipgreatsouthcoast.org.au

13