Queensland Indigenous Youth Leadership Program application form

Required fields are marked with an asterisk (*).

1. Eligibility

   1. Are you a Queensland resident? *

      You must be a Queensland resident to be eligible to apply.

      • Yes
      • No
   2. Are you 18–25 years old by 26 June 2021? *

      You must be 18–25 years old to be eligible to apply.

      • Yes
      • No
   3. Have you previously attended the program? *

      Previous participants of the program are not eligible to apply.

      • Yes
      • No
   4. Do you identify as any of the following? *

      The program is open to Aboriginal and Torres Strait Islander participants only.

      • Aboriginal
      • Torres Strait Islander
      • Aboriginal and Torres Strait Islander
      • None of the above
   5. Are you available to participate in the whole program in Brisbane from Saturday 26 June to Thursday 1 July 2021? *

      This is a residential program, meaning it is compulsory for all participants to stay at the designated venue for the duration of the program and attend all group activities and dinners.

      • Yes
      • No
2. Your details

   1. Given name *
   2. Familly name *
   3. Preferred name
   4. Gender *

      • Female
      • Male
      • Non-binary
      • Not listed here
      • Prefer not to say
   5. Gender not listed here
   6. Date of birth *
   7. Do you speak a language other than English at home? *

      • Yes
      • No
   8. Language spoken at home
   9. Email *
   10. Phone *
   11. Residential address

       1. Street address *
       2. 1. Suburb or town *
          2. State * QLD
          3. Postcode *
   12. Postal address

       If not the same as address above.

       1. Street address
       2. 1. Suburb or town
          2. State (select)QLD
          3. Postcode
   13. Resume * Maximum file size is 10MB.
3. How did you hear about the program? *

   • Email
   • Government website
   • Local paper
   • Radio
   • Social media (e.g. Facebook)
   • Word of mouth
   • Past participant
   • Other
4. Other
5. Leadership

   1. Why do you want to attend the program? * Maximum 2500 characters.
   2. What does leadership mean to you? * Maximum 2500 characters.
6. Community

   1. Where and how have you demonstrated leadership skills? * Your leadership experience could relate to work, family, school, studies, sport, community or previous leadership programs. Maximum 2500 characters.
   2. Describe the three most important issues affecting your community

      1. Community issue 1 * Maximum 2500 characters.
      2. Community issue 2 * Maximum 2500 characters.
      3. Community issue 3 * Maximum 2500 characters.
   3. Choose one issue from the previous question and describe how it could be addressed * Maximum 2500 characters.
   4. Thinking about what you said above, what might be a good community project? * Maximum 2500 characters.
7. Emergency contact details—next of kin

   Please nominate one person that the department can contact in case of an emergency, this person must know your medical history and have permission to talk on your behalf to medical staff.

   1. Name *
   2. 1. Relationship *
      2. Phone *
8. Alternative contact details

   Please nominate one person that the department can contact if, for whatever reason, we are unable to contact you. For example, if you have missed your flight.

   1. Name *
   2. 1. Relationship *
      2. Phone *
9. Referee contact details

   Please nominate two people that are not family members, which the department can contact to support and endorse your application.

   1. Referee 1

      1. Name *
      2. 1. Relationship *
         2. Phone *
   2. Referee 2

      1. Name *
      2. 1. Relationship *
         2. Phone *
10. Declaration

    1. I have read and understood the privacy notice and confirm that the information provided in this application is correct. *

       • Yes