2015 inspiring women fellowships

Application form

Title

Given name(s)

Surname

     

     

     

Application made by:

Nominee:|_| (provide name below) OR

Applicant:|_| (go to section 2)

Nominee Name

Nominee Job Title

Nominee Organisation

     

     

     

Undergraduate Degree |_|

Masters |_|

PhD |_|

Year completed:

Degree

     

Year completed

Masters

     

Year completed

PhD

     

Relevant professional

qualifications:

     

Currently Employed in STEM?

Yes: |_| No: |_|

Sector that best fits with your STEM experience:

Academic: |_| Industry: |_|

Your field:

If ‘Other’ please provide:

     

Name of most recent STEM Employer:

     

Job title at most recent STEM Employer:

     

Years employed in this role

FTE (Full Time Equivalent) in this role

Total number of FTE years in STEM roles

(A minimum of 10 years at 1.0 FTE in a academic and/or industry STEM sector(s) is required)

     

     

     

Are you looking to progress into leadership positions in Australia?

Yes: |_| No: |_|

Please respond to the selection criteria below (no more than half a page for each and a minimum of 250 words).

4.1

Why do you wish to join the Leading the Way stream of the 2019 inspiring women STEM sidebyside program for mid-career emerging leaders?

     

4.2

If successful in joining the program – how will you use the skills, experience and networks that you have garnered moving forward?

      

4.3

Discuss your success as a leader or potential as a future leader for women in STEM, including your ability to enhance cultural change as a promoter, supporter and mentor across Australia.

      

Postal Address line 1

Address line 2

     

     

Suburb

State

Postcode

Country

     

     

     

     

Email (must be accessible until 30 November 2018)

Phone (work)

Mobile Phone

     

     

     

Australian Citizenship1 |_|

Permanent Residency |_|

To which racial or ethnic group(s) do you most identify? We request this to better understand our current information reach and so guide future program advertising and recruitment. If you prefer not to provide this information tick here: |_|

     

I, , confirm that the information contained in my application is true and accurate. I agree that, as a condition of my forwarding this application, I permit the release of all materials that I have submitted for the purposes of the selection process. I understand that in the event of being selected for the STEM sidebyside program, my details will be publicised. I confirm that my manager at my current employer is aware of my interest to participate in the 2019 STEM sidebyside program and should my application be successful agrees to pay the financial contribution to secure my place on the program. Furthermore, I understand that should my application be successful my attendance at program event activities, to be scheduled throughout the year, will be required, with the first event to be held on: Thursday, 23 May 2019.

CHECK BOX & INSERT NAME AS CONFIRMATION|_|AGREEMENT MADE ON:       /       / 2019

I, , confirm that <, supports this application and agrees to provide a co-contribution of $975 to assist with program costs, should the applicant named within this application be selected to join the inspiring women STEM sidebyside program in 2019. In this instance, I confirm that $975 will be deposited and received into veski’s nominated financial institution no later than Friday, 7 June 2019. Failure to receive payment by this date may result in the candidate being unable to participate in the program sessions.

CHECK BOX & INSERT NAME AS CONFIRMATION|_| AGREEMENT MADE ON:       /       / 2019

Please attach a current Curriculum Vitae of no more than two pages to your application.

LinkedIn URL:

     

A PDF of your application must be lodged by 2.00pm (AEST), Thursday, 18 April 2019 via the veski website at: veski.org.au/inspiring-women/LTW-app. The file naming protocol to use is: applicant surname_applicant initial_LTW

A 100-word biography and headshot will be required at the stage of application submission via the veski inspiring women website. Applicants will be notified regarding the outcome of their application via email in May 2019.

1 Australian citizen, or a person who forfeited their Australian citizenship on the acquisition of another citizenship before 4 April 2002 under the now repealed Section 17 of the Australian Citizenship Act 1948, or a person who was forced to renounce their Australian citizenship under Section 18 of the Australian Citizenship Act 1948 in order to retain another citizenship or acquire another citizenship.