Fogarty Futures Conference 2020 Application
Name
*
First Name
Last Name
Gender
*
Female
Male
Prefer not to say
Other
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Are you from a rural or regional area?
*
Yes
No
If you are rural or regional do you wish to be considered for a travel grant to Futures 2020?
*
Yes
No
Not from a rural/regional area
Year Level in 2020
*
Year 10
Year 11
School
*
Is your school considered a low SES school?
*
Yes
No
Unsure
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What would you define as success for you personally over the next 10 years?
*
(Max 200 words)
Tell us about an issue that you care about. (This can be on any scale eg. local or global, but should be something that you feel passionately about).
*
(Max 200 words)
What do you do with your spare time?
*
(Max 200 words)
Who is a good leader and why?
*
(Max 200 words)
Why do you want to attend this conference?
*
(Max 200 words)
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Have you attended Futures before?
*
Yes
No
How did you find out about this conference?
*
If you are selected, do you expect to be able to pay the approximately $150 attendance fee? NB: This will not influence your candidacy.
*
Yes
No
Submit
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