Personal Information

Want to apply to take part in the Programme?  Please complete the following questions.

This nomination form captures general information alongside employment information and authorisation.

In the first instance this information will be used by a selection panel to determine your acceptance onto the Programme.  Should you be selected the administration team will use the information to verify your employer authorisation and invoicing, while the delivery team will use information on your studies and past experience as part of their preparation.  The information may also be used for programme evaluation and anonymously, in response and recovery research.

The data collected will also enable the Programme owner (DPMC) and the RRANZ consortium to monitor the  balance of organisations, experience and others aspects of diversity on each course and collectively over time.

Personal identification data is collected so that the programme administrators can verify your identity, a requirement of tertiary education.

All information collected in this nomination form and during the programme itself will remain confidential to you, your nominated supervisor, course administration, course assessors, and panels associated with the programme..

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* 1. What is your name?

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* 2. Date of Birth:

Date 

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* 3. Contact Details?

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* 4. Gender

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* 5. Ethnicity?

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* 6. Response / Recovery experience reflection:

Please detail your experience working in a leadership capacity in response and/or recovery contexts:  (500 words or less).

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* 7. Response / Recovery leadership training and development reflection:

Please give a high level overview of the training and development you have undertaken to prepare you to work in emergency response or recovery leadership roles: (500 words or less).

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* 8. Declaration:

By submitting this application to attend the RRANZ Response and Recovery Leadership Capability Development Programme, I declare that I am supported by my manager and organisation to fully attend and commit to the programme's learning requirements.

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