Confident Leaders Program Application Form

Confident Leaders Program - Gippsland 2027

Participant Application Form
Commencing 23rd March 2027
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?
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
Program 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 2027