Aboriginal and Torres Strait Islander Facilitator Directory Expression of Interest Form

The Queensland Department of Aboriginal and Torres Strait Islander Partnerships

If your Expression of Interest is successful, the information provided here will be used to create a simple profile of your business to be included with your entry in the facilitator directory.

Instructions:
Please answer all questions.
Two business client referees are required.

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* 1. Business details. An ABN or ACN must be provided.

Business Name:

Contact Name:

Contact Email:

Contact Phone:

ABN or ACN:

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* 2. Are you listed, or eligible and agree to be listed, on the Black Business Finder website? (See eligibility categories. If you are eligible and you would like to be listed, we will organise it at no cost.)
If no, but you still believe you should be considered for this opportunity, please explain why. (It won't effect your application.)

Yes

Yes, I'm eligible and agree to be listed on the Black Business Finder website

If "No", but you believe there are reasons why you should still be considered, explain why:

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* 3. Please provide a brief summary of your skills as a facilitator or trainer.

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* 4. Please outline your experience over the last three years in delivering workshop facilitation services. Include client business names.

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* 5. Referee 1

Name *

Company *

City/Town

Email Address *

Phone Number *

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* 6. Referee 2

Name *

Company *

City/Town

Email Address *

Phone Number *

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* 7. This is a state-wide initiative. What Queensland regions are you willing to deliver your services to? Select all that apply. (Note that these are not strictly defined areas but rather notional areas. The discretion to deliver services in these areas remains with the facilitator.)

Cairns & Far North Queensland

Mount Isa & North West Region

The Central West

South West & Darling Downs

Townsville

Mackay Whitsunday Region

Rockhampton

Gladstone

Wide Bay Burnett

South East Queensland

All of the above

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* 8. Do you have a Certificate in Training and Assessment, or higher Teaching qualification? Please give a brief description of the qualification.

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* 9. Please upload a scan or photo of your qualification documentation.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Terms and Conditions:
1. The Department of Aboriginal and Torres Strait Islander Partnerships reserves the right to refuse any application.
2. Successful applicants remain on the Facilitator Directory for three years.
3. DATSIP reserves the right to remove any person from the Facilitator Directory based on behaviour deemed inappropriate by DATSIP staff and/or their agents and others working under their authority.
4. Delegates agree to be contacted via phone, email, SMS or other means for the purpose of sharing information and updates.
5. DATSIP reserves the right to use any recordings whether audio or video and/or any photographs taken at any stage during a workshop for the purposes of reporting and advertising on Queensland Government websites.
6. DATSIP may vary the Terms and Conditions at any time and they become effective upon posting on its corporate websites or other corporate publications.