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* 1. Name

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* 2. Address

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* 3. Email

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* 4. Phone

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* 5. Mobile

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* 6. Which Community Advisory Council region do you live or work in?

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* 7. Do you identify as Aboriginal and/or Torres Strait Islander?

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* 8. Keeping in mind the key selection criteria, please tell us why you are interested in joining the Community Advisory Council.
(Please keep your answers to under 500 words)

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* 9. Please describe the value that you would add to the Community Advisory Council in terms of specific knowledge, skills and experience.
(Please keep your answers to under 500 words)

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* 10. Would you like to be considered for the role of advisory council chair?

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* 11. Please tell us about your experience in any of the following as a consumer, carer, or person with lived experience: (please keep your answers to under 500 words)
  • People with a disability
  • Families and carers
  • People with chronic conditions
  • Mental health
  • Addiction services
  • People from culturally and linguistically diverse (CALD) populations
  • Children and youth
  • Aboriginal and/or Torres Strait Islander health
  • People with social disadvantage
  • Lesbian, gay bi-sexual transgender or intersex

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* 12. Please provide the names and contact details for two referees willing to provide information on your skills and experience.

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