Yorga Djenna Bidi Aboriginal Women's Leadership Program Application Form 2025
The following questions relate to information and dates outlined in the Application Information Handbook on the WAALI website. (www.waali.org.au) Please read this document before applying.
Please tick which cohort you are interested in applying for -
Cohort 1: February - July
Cohort 2: August - December
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Personal Email Address
*
example@example.com
Personal Phone Number
*
Please enter a valid phone number.
Employer. (please add Line Manager title, name, contact details)
*
What status best reflects your current situation
*
Employed part-time
Employed full-time
Studying part-time
Studying full-time
Home duties
Volunteering
Other
Work Email
*
example@example.com
Work Phone Number
*
Please enter a valid phone number.
How did you hear about the Yorga Djenna Bidi Program?
*
Have you read the Yorga Djenna Bidi Applicant Information Handbook on our website?
*
Yes
No
Have you undertaken Leadership training previously? If so, please list.
*
Please describe why you want to undertake the Yorga Djenna Bidi Program.
*
Are you available to participate on the program dates listed in the Applicant Information Handbook on our website?
*
Yes and I note the attendance requirements
No
Please provide a brief description of your current role.
*
If you are employed, have you discussed your participation with your line manager and provided a copy of the Information for Employers brochure?
*
Will your employer be financially supporting your participation and assisting you with travel and accommodation - as outlined in the Applicant Information Handbook?
*
Yes
No
If you are not employed are you seeking a scholarship to undertake the program?
*
Yes
No
If you live in a rural or remote region of Western Australia, please ensure you or your employer can provide assistance with travel and accommodation before applying
*
I understand
I acknowledge by ticking the Yes box that I give permission to share my name with the scholarship funder.
*
Yes
No
Describe what you hope to gain from participating in the program?
*
Describe what you bring to the program. (Knowledge, experience, community roles, volunteering etc)
*
What is your level of education experience?
*
Primary School
Secondary School
TAFE
University
Are you available to attend a Teams interview?
*
Yes
No
Do you identify as an Aboriginal and/or Torres Strait Islander Australian, and are you accepted in the community as such?
*
No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both Aboriginal and Torres Strait Islander
If yes to the above, please confirm your language group/s.
*
Please note that you may be required to provide a cultural reference as evidence of your family heritage prior to acceptance into the program. Will this be an issue for you?
*
Please provide a professional reference and contact details. (phone and email address) A professional referee can include an employer, former employer, client, colleague, teacher, supervisor, volunteer lead. Please contact WAALI if you would like to discuss.
*
Emergency and Medical Information
Do you have any food allergies? If yes, please list them.
*
Do you have any dietary requirements? If yes, please list them.
*
Are you allergic to any medications? If yes, please list them.
*
Are you currently taking any medications? If yes, please list your medications.
*
Do you have any medical conditions? if, yes, please list below.
*
Have you been hospitalised in the past year?
*
Have you had any surgeries in the past year?
*
Do you have Ambulance cover?
*
Yes
No
I give permission for WAALI staff to call an ambulance for me in an emergency and agree to any costs incurred.
*
Yes
No
Emergency contact - Full name of person to be contacted.
*
Phone Number of emergency contact
*
Please enter a valid phone number.
Email address of emergency contact
*
example@example.com
The Western Australian Aboriginal Leadership Institute (WAALI) does not accept any liability for the provision of first aid nor medical/psychological management of participants. This information is for the purpose of emergency management only.
*
I understand
Media Release Consent I hereby irrevocably consent without royalty or other compensation of any kind, to the use, for any lawful purpose, including but not limited to advertising and trade purposes by the Western Australian Aboriginal Leadership Institute of my name, voice and any portraits, likeness pictures, images, video, film and photographs of me taken by or on behalf of the Western Australian Aboriginal Leadership Institute and reproductions of the same in any form, in any medium, including on the World Wide Web, hereby releasing the Western Australian Aboriginal Leadership Institute from all liability arising from use of images including what I might deem misrepresentation of me by virtue of distortion, optical illusions or faulty mechanical reproductions. I agree that all such images whether plates, transparencies, negatives, films, video, audio, electronic, digital, and/or any medium now or hereafter utilized connected therewith are and shall remain the property of the Western Australian Aboriginal Leadership Institute. All copyrights, rights of publicity and other intellectual property rights images shall belong to the Western Australian Aboriginal Leadership Institute and if requested, I will execute any additional agreements to evidence these rights. I further agree to the use of statements made by me about the Western Australian Aboriginal Leadership Institute and its various activities for advertising and trade purposes by the Western Australian Aboriginal Leadership Institute. I acknowledge that this release constitutes the entire understanding with the above parties, all prior understandings, if any, being merged herein.
*
I agree
I do not agree
Please provide a recent photograph of yourself (compulsory)
*
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Is there anything else you would like to share with WAALI?
If you are not successful for the 2025 cohort dates, would you like to be considered for future cohorts?
*
Yes
No
Disclaimer. I understand that the Yorga Djenna Bidi Program includes topics that may cause distress, and that I will seek support where necessary from counsellors and medical professionals. The WAALI team will do it’s best to provide a safe environment but is not medically qualified to undertake counselling or mental health services. I understand that I am responsible for my mental health and will seek appropriate supports when necessary.
*
Yes
No
WAALI follows the WA State Government guidelines regarding Covid-19. If the WA Government were to require you to be vaccinated, would you be considered fully vaccinated?
*
Yes
No
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