Confident Leaders Program Application Form

Confident Leaders Program - Gippsland 2026

Participant Application Form
Commencing 31st March 2026
Name:*

First NameLast Name
Preferred name
Position*
Business / Organisation*
Organisation details*

Address

Address 2

TownState

Post Code
E-mail*
example@example.com
Phone Number*
Manager Name*
Manager Position*
Manager Email*
Manager Phone*
Desired outcome from the program?*
Greatest current leadership challenge?*
How did you hear about the program?
Is there any reason you are unable to commit to the expectations of the program as outlined in the program overview?*

YESNO
If YES, please provide more information
Do you have any dietary requirements?*
Do you have any special requirements? (eg disability)*
To help with venue planning, which town will you be travelling from?*
Program cost*

I am aware the cost of the program is $5,700 +GST
Program funding*

My manager has agreed to sponsor my place in the programI will be self-funding
Please only submit this form if your Manager agrees to:
- Fully support you with the cost of the program (unless you are self-funding)
- Make the time and resources available to ensure you can fully participate in the program
- You attending all workshops in person
Should be Empty:

Confident Leaders Program - Gippsland 2026