2024 - 2025 Regional Leadership Development Program Registration Form

Personal Information

Please check the criteria before you apply to see if you are eligible for this program and its streams.

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* 1. First Name:

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* 2. Last Name:

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* 3. Contact phone number:

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* 4. Contact email address:

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* 5. What is your residential postcode?

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* 6. In which Local Government Area of South Australia do you reside?

Barunga West Council

Clare and Gilbert Valleys Council

Copper Coast Council

Regional Council of Goyder

District Council of Mount Remarkable

Northern Areas Council

District Council of Orroroo Carrieton

District Council of Peterborough

Port Pirie Regional Council

Wakefield Regional Council

Yorke Peninsula Council

Other (please specify)

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* 7. What is your gender?

Male

Female

Non-binary

Prefer not to say

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* 8. Are you of Aboriginal or Torres Strait Islander origin?

Yes

Prefer not to say

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* 9. Do you have a culturally and linguistically diverse background?

Yes

Prefer not to say

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* 10. Do you have a disability?

Yes

Prefer not to say

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* 11. What is your current labour force status?

Employed - full-time

Employed - part-time

Unemployed (looking for work)

Not employed (not looking for work)

Retired

Student

2024 - 2025 Regional Leadership Development Program Registration Form

Personal Information

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Contact phone number:

Question Title

* 4. Contact email address:

Question Title

* 5. What is your residential postcode?

Question Title

* 6. In which Local Government Area of South Australia do you reside?

Question Title

* 7. What is your gender?

Question Title

* 8. Are you of Aboriginal or Torres Strait Islander origin?

Question Title

* 9. Do you have a culturally and linguistically diverse background?

Question Title

* 10. Do you have a disability?

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* 11. What is your current labour force status?

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* 12. What is your highest level of educational attainment?

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* 13. What is your current (or most recent) industry of employment?