North Richmond Community Leadership Program

    EXPRESSION OF INTEREST

    About You

    First Name

    Last Name

    Gender

    Year of Birth

    Country of Birth

    Cultural Heritage

    Are you an Aboriginal or Torres Strait Islander person?
    YesNoPrefer not to say

    Post Code

    Phone number

    E-mail Address

    What is your connection to the North Richmond Precinct? Tick all that apply
    WorkLiveStudyVolunteerOther

    Please provide details about your connection to the North Richmond Precinct.

    Do you need any assistance accessing the program? Please specify

    What are your dietary requirements?

    Whilst we will endeavour to cater to all dietary requirements, we strongly advise you to refrain from consuming food or drinks at the sessions if you have allergies, intolerance of any kind and/or dislike to food prepared by a commercial outlet.

    Program Delivery

    Most of the program will be delivered using an online delivery platform such as Teams or Zoom. Please select your preferred time and day for the online sessions. Please note that time slots with majority vote will be chosen for the purpose of scheduling. Please select two options that suit you the most

    First Choice
    Monday 10.30-12.30Monday 18.00-20.00Tuesday 10.30-12.30Tuesday 18.30-20.30Wednesday 10.30-12.30Wednesday 18.30-20.30Thursday 10.30-12.30Thursday 18.30-20.30

    Second Choice
    Monday 10.30-12.30Monday 18.00-20.00Tuesday 10.30-12.30Tuesday 18.30-20.30Wednesday 10.30-12.30Wednesday 18.30-20.30Thursday 10.30-12.30Thursday 18.30-20.30

    Why are you interested in participating in this community leadership program? Tick all that apply
    I want further knowledge and experience in being a leader in my communityI want to make connections with other community membersIt will help me with my studies and career progressionTo improve my self-confidence and communication skillsTo develop my plans to start a business or secure employment
    Other:

    Are you currently involved in the North Richmond Precinct community in any of the following ways? Please tick all that apply.
    No, I am not involvedI am a member of a committeeI support community members to find solutions to community issuesI advocate for the local communityI volunteer my time at a local not-for-profit organisationI run a small local support group

    Please provide details to the question above: Your current involvement in the North Richmond Precinct community

    How do you expect this program to strengthen your skills as a community leader? Please tick all that apply.
    Increased self-confidencePublic speaking and advocacy skillsRunning effective meetingsProject planningTeamworkBusiness planningBudget planningPartnership DevelopmentGrant writingNetworkingEngaging with various levels of government
    Other:

    Capturing community stories

    To celebrate your participation in this program and to capture your voices, we would like you to share your stories of community leadership on camera. The images captured will be put together and presented in a short video format. The video will be shared with the Department of Families, Fairness & Housing, North Richmond Community Health, and will feature on the website of Track C Consulting. Please indicate if you consent to participate in this activity:
    Yes, I agree to participate in the video projectNo, I do not wish to participateI need more information

    Photo consent

    We would like to take photos and short videos during the course of the program for evaluation, celebration and evidence of successes of the program. Photographs and videos will be shared with delegates of Department of Families, Fairness & Housing, North Richmond Community Health and Track C Consulting
    If you consent to your images to be captured, please tick the box below.

    Future correspondence

    Track C Consulting would like to send you updates, newsletters and information about future training and project opportunities.
    Do you agree to receive information via email?
    YesNo

    Thank you for your expression of interest. We will review your responses and get in touch with you in the next 2 weeks. If you have any questions, feel free to email Pirooz Jafari at info@trackc.com.au.