LBWR20 application

LBWR20 Application Form

Fill out the form carefully for registration
Instructions and advice for applicants
- We recommend using a word processor before pasting the content into the form
- Please read the application form carefully and complete each section in full
- Applicants must have full support of the organisation they represent
- Short-listed applicants will be interviewed by a selection panel in late 2019
- The selection panel will be made up of LBWR staff, committee members and alumni
- Individuals may nominate themselves
- Attendance for the duration of LBWR20 is mandatory, including opening and closing retreats
- LBWR20 has a 100% attendance target. 80% attendance is required to graduate
- Diversity of gender, location, public and private sector employees, for-profit and not-for-profit participants will be sought
- LBWR is committed to the selection of participants from across Ballarat and the Western Region
- Offers for LBWR20 will be made in December 2019
- LBWR20 will commence in February 2020 and conclude in November 2020
- Employer/sponsor contribution for LBWR20 is $4567 exc GST and Participant contribution for LBWR20 is $1444 exc GST
- Program fees must be paid prior to commencing LBWR20 unless otherwise arranged with the Executive Officer
- The contribution of fees paid by an employer and participant can be negotiated. LBWR will not be involved in these negotiations
- A range of scholarships will be offered annually, details for these can be found at the LBWR website
- All applications are subject to a confidential evaluation
Applicant Name

First NameLast Name
Gender
Birth Date

MonthDayYear
Personal Address

Street Address

Street Address Line 2

CityState

Postal Code
Personal Email
Mobile Number
Employment details
Work Email
Work Phone Number
Business Address

Street Address

Street Address Line 2

CityState

Postal Code
Employment / Experience
Please provide a brief description of your current role, who your employer is and your responsibilities
Minimum 30 words
Please list other relevant employment experience (including dates)
What do you consider your proudest professional achievement to date?
Minimum 30 words
Education
What organisational leadership skills do you hope to gain from participating in LBWR?
List leadership training courses/units you have completed via your study, your employment or through volunteer work
Please list your education experience/qualifications (including dates)
Will you be enrolled in any other formal/accredited training next year? If yes please specify

References

Please list two (2) people other than your employer/sponsor who are knowledgeable about your leadership performance and potential
Reference 1 Name
Reference 1 Title and Organisation
Reference 1 Phone Number
Reference 2 Name
Reference 2 Title and Organisation
Reference 2 Phone Number

Commitment

LBWR20 is a one-year program commencing in February 2020 and concluding in November 2020.

LBWR20 has a 100% attendance target and minimum 80% attendance is required to graduate.

Program Breakdown:
- Opening retreat in February (two days, one night) – compulsory
- Average of two program days/evenings per month (which may include field trips). Program days: 9am-5pm. Program evenings: 5pm-9pm. Meals included
- Program day/evening preparation and follow up is required, including surveys and reflections (up to 3 hours every fortnight)
- Trips to Canberra and Melbourne (two to three days each, all costs covered by LBWR)
- Learning Partner for each participant
- Closing retreat in November (two days, one night) – compulsory
I agree and understand

yes
Investment

LBWR20 operates on the generosity of our program partners and government.

With the exception of scholarship recipients, we ask each participant to pay a fee of $1444 + GST and their employer to pay a fee of $4567 + GST, payable upon acceptance into the program.

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

yes
Personal Commitment

I understand the goals and time commitments of LBWR20.

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 LBWR through its alumni program.

Any Information and photographs taken throughout LBWR20 may be used for promotion and media releases, including the LBWR website and associated websites and social media platforms.
I agree and understand

yes
Employer Commitment

My employer has given their full support of my participation in LBWR20.

They are fully aware of the time commitments and organisational financial commitment of $4567 + GST associated with it.
Employer's Name
Employer's Title
Organisation
I agree and understand

yes
Date

MonthDayYear
Date

Scholarships

LBWR makes a number of scholarships available annually. Scholarship criteria are set by scholarship sponsors in discussion with LBWR. Please refer to the website for more information.

The LBWR 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, etc.
Do you wish to apply for a scholarship place?

YesNo
Which scholarships do you wish to apply for?

Leaders In Action Scholarship (active citizenship)Peter Davies Scholarship (small business owner/entrepreneur)Pyrenees Shire Community Scholarship (resident or employee)Bank Australia Indigenous Scholarship (Aboriginal or Torres Strait Islander)Agriculture Victoria Scholarship (biosecurity)Emerging Young Leaders (People @ Work/Gforce)
Please provide the selection panel with your motivation for this scholarship application (required field if applying for a scholarship)
Minimum 30 words
Should be Empty:

LBWR20 Application Form