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Women's Community Sport Leadership Program- Expression of Interest

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* 1. Your Details:

Name

Employer / Sports Organisation

Residential Postal Code

Email Address

Phone Number

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* 2. Gender:

Woman

Man

Prefer not to say

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* 3. How long have you been employed or volunteered in community sport?

Less than 1 year

1-2 years

2-5 years

5-10 years

10 plus years

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* 4. What are your current roles in sport? Please include organisation name and role.

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* 5. Which Local Government Area is your organisation located in?

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* 6. Are you currently involved in any other leadership programs?

Yes

Unsure

Please list the name of the program as required:

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* 7. Considering that this leadership program is designed to discuss and better understand gender equity issues in community sport across Gippsland, please rate yourself on a scale of 0-10 for the following statements:

	(Lowest) 0	1	2	3	4	5	6	7	8	9	(Highest) 10
I am aware of my responsibilities and what I could/need to do to address this topic	I am aware of my responsibilities and what I could/need to do to address this topic (Lowest) 0	I am aware of my responsibilities and what I could/need to do to address this topic 1	I am aware of my responsibilities and what I could/need to do to address this topic 2	I am aware of my responsibilities and what I could/need to do to address this topic 3	I am aware of my responsibilities and what I could/need to do to address this topic 4	I am aware of my responsibilities and what I could/need to do to address this topic 5	I am aware of my responsibilities and what I could/need to do to address this topic 6	I am aware of my responsibilities and what I could/need to do to address this topic 7	I am aware of my responsibilities and what I could/need to do to address this topic 8	I am aware of my responsibilities and what I could/need to do to address this topic 9	I am aware of my responsibilities and what I could/need to do to address this topic (Highest) 10
I am confident I can complete & address what I need to do for this topic	I am confident I can complete & address what I need to do for this topic (Lowest) 0	I am confident I can complete & address what I need to do for this topic 1	I am confident I can complete & address what I need to do for this topic 2	I am confident I can complete & address what I need to do for this topic 3	I am confident I can complete & address what I need to do for this topic 4	I am confident I can complete & address what I need to do for this topic 5	I am confident I can complete & address what I need to do for this topic 6	I am confident I can complete & address what I need to do for this topic 7	I am confident I can complete & address what I need to do for this topic 8	I am confident I can complete & address what I need to do for this topic 9	I am confident I can complete & address what I need to do for this topic (Highest) 10
I am aware of tools and resources available to support my work to address this topic	I am aware of tools and resources available to support my work to address this topic (Lowest) 0	I am aware of tools and resources available to support my work to address this topic 1	I am aware of tools and resources available to support my work to address this topic 2	I am aware of tools and resources available to support my work to address this topic 3	I am aware of tools and resources available to support my work to address this topic 4	I am aware of tools and resources available to support my work to address this topic 5	I am aware of tools and resources available to support my work to address this topic 6	I am aware of tools and resources available to support my work to address this topic 7	I am aware of tools and resources available to support my work to address this topic 8	I am aware of tools and resources available to support my work to address this topic 9	I am aware of tools and resources available to support my work to address this topic (Highest) 10
I have the confidence to make improvements in my work around this topic	I have the confidence to make improvements in my work around this topic (Lowest) 0	I have the confidence to make improvements in my work around this topic 1	I have the confidence to make improvements in my work around this topic 2	I have the confidence to make improvements in my work around this topic 3	I have the confidence to make improvements in my work around this topic 4	I have the confidence to make improvements in my work around this topic 5	I have the confidence to make improvements in my work around this topic 6	I have the confidence to make improvements in my work around this topic 7	I have the confidence to make improvements in my work around this topic 8	I have the confidence to make improvements in my work around this topic 9	I have the confidence to make improvements in my work around this topic (Highest) 10
I have the knowledge & skills to improve my work to address this topic	I have the knowledge & skills to improve my work to address this topic (Lowest) 0	I have the knowledge & skills to improve my work to address this topic 1	I have the knowledge & skills to improve my work to address this topic 2	I have the knowledge & skills to improve my work to address this topic 3	I have the knowledge & skills to improve my work to address this topic 4	I have the knowledge & skills to improve my work to address this topic 5	I have the knowledge & skills to improve my work to address this topic 6	I have the knowledge & skills to improve my work to address this topic 7	I have the knowledge & skills to improve my work to address this topic 8	I have the knowledge & skills to improve my work to address this topic 9	I have the knowledge & skills to improve my work to address this topic (Highest) 10
I am ready to make improvements in our workplace around this topic	I am ready to make improvements in our workplace around this topic (Lowest) 0	I am ready to make improvements in our workplace around this topic 1	I am ready to make improvements in our workplace around this topic 2	I am ready to make improvements in our workplace around this topic 3	I am ready to make improvements in our workplace around this topic 4	I am ready to make improvements in our workplace around this topic 5	I am ready to make improvements in our workplace around this topic 6	I am ready to make improvements in our workplace around this topic 7	I am ready to make improvements in our workplace around this topic 8	I am ready to make improvements in our workplace around this topic 9	I am ready to make improvements in our workplace around this topic (Highest) 10

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* 8. I have read and understood the information provided about this women's leadership program and that will run until December 2021.

Yes

Unsure