Application Form

Please read through the Changemaker Course Application Guidelines document before completing this form. If you have any questions or technical difficulties, please email learning@centralcoast.nsw.gov.au

Applications close at midnight on Mon 28th March 2022

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* 1. Full Name

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* 2. Mobile Number

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* 3. Email Address 

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* 4. Postal Address

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* 5. Please confirm that you are applying to attend the Changemaker Course on behalf of yourself

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* 6. What is your age? (Parental permission is required for applicants aged 16 and 17 years old)

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* 7. Please indicate your current employment status.

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* 8. If you are currently employed, studying or volunteering, please tell us about your role or area of expertise.

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* 9. Do you identify as an Aboriginal or Torres Strait Islander origin?

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* 10. Is English your first language?

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* 11. If no, what is the primary language spoken at home?

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* 12. Of all the topics included in the Changemaker program, you are most interested in: (Please rank them from 1 - most interested to 8 - least interested)

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Schedule

Schedule

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* 13. If successful, would you be able to attend all the workshops, the field trip and the celebratory gathering?

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* 14. Catering is provided at all workshops. Do you have any dietary requirements or allergies?

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* 15. Do you have any medical conditions, mobility restrictions or concerns that we should be aware of?

Have you got a community waterways project or idea you are passionate about? The Changemaker Course can help transform your ideas into reality! As part of the application process, we would love to hear an example of an idea that you are passionate about - but don't worry if your ideas are still forming, being adaptable and open-minded to change, new and different ideas is all part of the process!

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* 16. Please select the most appropriate outcome(s) you would like to achieve though your own project development:

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* 17. Please select a category that best fits your idea

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* 18. Please provide a brief description of your project idea or passion

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* 19. Name the primary location(s) for your project idea or passion

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* 20. What would you like to achieve by implementing your idea?

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* 21. Describe how your idea will achieve the outcome(s) identified in the question above:

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* 22. How many people do you anticipate will be involved as participants if your idea was implemented?

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* 23. Would your idea require any support from Council staff?

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* 24. If yes, please indicate the nature of the support? (Select all that applies)

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* 25. If successful, do you intend to apply for the Changemaker Program grant or any other grants?

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* 26. If you apply and successfully obtain the Changemaker Program grant funding, would you be able to implement the idea from July to December 2022?

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* 27. Do you agree to participate and contribute positively to promote a safe and fun learning environment for everyone involved?

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