Tasmanian Leaders Inc
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Tasmanian Leaders Acceptance Form
TLP Program Acceptance Form
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" indicates required fields
Your name
Name
First
Last
Program Acceptance Questions
I hereby accept the offer by Tasmanian Leaders of a place on the 2022 Tasmanian Leaders Program.
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Yes
Program Dates
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I agree to attend the sessions as detailed in the program offer I received
Terms and Conditions
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I agree to be bound, and continue to be bound, by the Terms and Conditions published by Tasmanian Leaders which may be amended from time to time. I recognise that the Terms and Conditions impose a range of obligations on me and they also, among other things, limit any potential liability Tasmanian Leaders may have otherwise had to me.
www.tasmanianleaders.org.au/terms-and-conditions
Program fees
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I understand that by submitting this form and accepting a place on the 2022 Tasmanian Leaders Program I am committing to paying the participant contribution of $1,200, noting the non-refundable deposit of $550 is due by Monday 20 December.
www.tasmanianleaders.org.au/terms-and-conditions
Participant Charter
In accepting an offer to undertake the Tasmanian Leaders Program (TLP), you acknowledge the following undertakings. As a participant of the 2022 Tasmanian Leaders Program, I will:
Participant Charter
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Respect: Show professional respect to my fellow participants, speakers and all guests of the program.
Participant Charter
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Prepare and participate: Read the materials provided before each session and participate fully in every session I attend. Complete all feedback forms in the time allocated and participate in ongoing TLP reviews and evaluation as requested.
Participant Charter
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Attendance: Undertake to attend all program events including the opening, mid-year and closing residentials and all the linking sessions. I understand that full benefit from the program can only be gained by full attendance and I acknowledge the expectation that participants will only be absent from program sessions in exceptional circumstances. In the unlikely event that such circumstances arise, I understand this will be resolved through discussion between myself, the CEO and members of the Board and may impact on the benefits I gain from being on TLP and my eligibility to graduate from the program.
Participant Charter
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Learning Set Project: Form a small group with fellow participants, a Learning Set, and plan, develop, initiate and deliver an external community or business development project either during or following the completion of the program.
Participant Charter
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Skillsbank and Thinkbank: Register my skills and interests with Skillsbank and commit to undertaking ongoing volunteer opportunities with community based organisations such as board placements, public speaking and mentoring. I will also commit to keeping my contact details current with Tasmanian Leaders and to participate in Thinkbank, a process that involves TLP graduates in critical conversations that facilitate positive change for Tasmania’s future.
Participant Charter
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Community development and leadership: Strive to actively participate in community development through public or community leadership in order to give back to the community which supported my participation.
Participant Charter
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Promotion and development: Assist with the promotion and development of Tasmania and the Tasmanian community regardless of where in the world I may be based from time to time.
Let us know what details you would like on your name badge
Preferred name, role, and the company you are representing
Preferred name
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e.g. Ange Driver instead of Angela Driver
Role
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e.g. CEO
Company you are representing
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e.g. Tasmanian Leaders Inc.
Details of primary emergency contact
Name
*
Full name
Relationship to you
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Husband, wife, partner, parent, brother, sister, etc.
Phone (primary)
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#### ### ### or landline ## #### ####
Phone (secondary)
#### ### ### or landline ## #### ####
Would you like this person to make requests on your behalf?
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Yes
No
Details of secondary emergency contact
Name
Full name
Relationship to you
Husband, wife, partner, parent, brother, sister, etc.
Phone (primary)
#### ### ### or landline ## #### ####
Phone (secondary)
#### ### ### or landline ## #### ####
Would you like this person to make requests on your behalf?
Yes
No
Employer contact details
Employer
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Your organisations name
Manager name
First
Last
The name of your direct manager who will be receiving your employer updates, as well as invites to networking events throughout the program.
Managers email
*
Your managers email address for communications
Please send my employer invoice to
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Please provide full name of person (it might be yourself)
Employer invoice email
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A current email address to receive the employer invoice
Medical, dietary, and accessibility
We want to ensure we are able to support your participation in the program
I have a medical condition that will impact my participation
I have dietary restrictions
I have accessibility needs to allow me to fully participate
If you have a medical condition, please detail the dates, duration and outcome of the illness or condition
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If you have dietary requirement, please detail and include dietary choices such as vegetarian/vegan
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If you have accessibility needs, please detail things that might affect access to venues, capacity to sit for long periods etc
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Communicate and share information during the program
To enable us to communicate and share documents with you during your program experience, we will be establishing a Microsoft Teams account. To help set this up, please confirm the email you would like the account invitation to be sent to? This email will be used for logins and notifications. If you already have a Microsoft Teams account you might like to use the same email address.
Please supply the primary email address you used to apply to the program
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The email address you received the form link from
Would you like to use the same email address for Microsoft Teams?
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Yes
No, I would like to use an alternate email
If no, please supply an alternate email address
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A little bit more information
Photo
Please upload a recent photo (headshot), this will be used to share with participants at the start of your program
Participant photo
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Max. file size: 64 MB.
A head and shoulders photo
Consent
I give consent to Tasmanian Leaders to share my mobile number and email with my fellow participants
I have received all required Covid-19 vaccinations
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Yes
No
Covid-19 digital certificate
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Max. file size: 64 MB.
I have a current Working with vulnerable people's card
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Yes
No
I'd prefer not to say
This card may be required for some venues, but is not essential.
WWVP card number
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WWVP expiry date
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