NRWC MUSTER 2023

NRWC MUSTER 2023
Name

First NameLast Name
Email
example@example.com
Phone
Mobile
Federal Electorate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment
Have you previously participated in NRWC program/s? If yes, which one/s?
Have you participated in any other personal/professional development programs over the last three years? (in person or virtual) - Please list
Please provide your Social Media Handles:
DOB

MonthDayYear
Date
Country of birth
Which intersection do you identify as? You can tick more than one.

RRR womenAboriginal or Torres Strait Islander WomenWoman with a DisabilityLGBTIQ+Culturally & Linguistically Diverse
Please list the Community groups or networks you are involved in:
Rate your leadership skills:

BasicIntermediateAdvanced
List three (3) aspects of leadership you hope to learn from this program?
Where do you want your leadership journey to take you? What are your leadership goals?
What do you believe are the (3) three major issues facing rural Australia today?
If you could influence change on your (3) three issues, would you?

YesNoUnsureOther
What is your level of comfort towards public speaking

PetrifiedBasicIntermediateAdvancedOther
Are you currently on a Board or Community Committees?
How do you rate you Board room/governance skills?

BasicIntermediateAdvanced
Provide an example when you have needed to be assertive in a Boardroom/ committee environment. What were the circumstances, what was your action and what was the result?
Population of your community:
Please provide a snapshot of your community? Issues, strengths, economic factors, demographic etc.
What ‘gap’ in your community will your volunteer project hope to fill? What is the positive outcome you will achieve through your volunteer project?
Please provide an outline of your proposed community volunteer project? Purpose, longevity, stakeholders, participants, how you will measure success etc
Please indicate the area your volunteer project is focused on:
Please provide an timeline of your proposed community volunteer project?
Estimate how many people will attend your volunteer project?
Estimate how many people your volunteer project will affect indirectly?
Confirm your community project is not directly related to your employment or business.

Yes – not related to my employment or business
Confirm your volunteer community project can be completed by March 2024

YesNoOther/Why
What is the (1) one thing you think you personally need to make a leader or an advocate?
Please upload:

1 x Profile photo – Head & Shoulders
Cancelof
Please upload:

1 x Photo of you in-front of your town sign or town identifying landmark
Cancelof

Photo/Video Publicity Consent and Right to use Information Form and Rights to Use & Distribute Agreement Form.

I grant permission to the National Rural Women’s Coalition (NRWC), its agents and contractors the irrevocable and unrestricted right to reproduce photographs and/or video images of me or my project, reports or survey results for the purpose of publication, promotion, illustration, advertising, reporting or trade, in any manner or in any medium.

These could include:
• external publications such as newspapers and magazines
• publications, such as posters, newsletters, brochures, booklets and displays
• television and radio segments or advertisements
• intranet and internet sites including but not exclusive to Facebook, Twitter and YouTube
• internal messages, articles and newsletters
• testimonials
• reports

Privacy Information

The collection of personal information by the NRWC Ltd in relation to this consent form is for the purposes of recording your acceptance to the terms and conditions under which the NRWC can use your images or audio-visual recordings, survey results, report or project findings . If you do not provide the relevant personal information requested in this consent form, the NRWC you will be unable to participate in the program.

Your personal information will be used and stored in accordance with the Privacy Principles.

Rights to Use & Distribute
Reports/Survey Results/Videos/Social Media/Recordings produced by the NRWC or by participants or presenters as part of a NRWC program become the property of the NRWC and can be used, in entirety or in part and distributed by NRWC and its agents as needed by the NRWC.
Please verify that you are human*
Should be Empty: