LeadershipEcosystem APPLICATIONFORM PERSONAL DETAILS Name * First Name Last Name Email * Phone * Country (###) ### #### State/Territory * NSW VIC QLD WA SA TAS ACT NT PROFESSIONAL BACKGROUND Current Role/Position * Eg. Primary School Teacher, Deputy Principal, Head of Department. School/Institution Name * Years of Teaching Experience * 0-2 years 3-5 years 6-10 years 11-15 years 16-20 years 20+ years Years in Leadership Roles * No formal leadership experience 0-2 years 3-5 years 6-10 years 10+ years Highest Educational Qualification * Bachelor's Degree Graduate Certificate Graduate Diploma Master's Degree Doctorate Other PROGRAM ENGAGEMENT Program Commitment Information The Leadership Ecosystem is a 12-month program. Each term there will be a full day of leadership training, and an online masterclass (usually held after hours) of 2-3 hours. In addition, we recommend you allocate 1-2 hours a week to review the resources provided and engage in cohort discussions. What motivates you to join the Leadership Ecosystem? * Across the 12-month period, what are some of the things you would like to achieve as a result of your participation in the Leadership Ecosystem? * Which areas of leadership development are most important to you? * Select all that apply. Strategic Planning Emotional Intelligence Dealing with Conflict Managing Team Dynamics Communication Skills Change Management Building School Culture Data-Driven Decision Making Conflict Resolution Innovation & Technology How will you manage the time commitment for this program? * Select all that apply. Early morning study sessions Evening study sessions Weekend focused Flexible schedule throughout the week Some time during school hours Mixed approach ADMINISTRATIVE DETAILS How did you hear about this program? * Colleague recommendation School leadership team Professional network Social media Education department communication Website/Google search Professional development event Other Emergency Contact Details Emergency Contact Name * First Name Last Name Emergency Contact Phone * Country (###) ### #### Relationship to you * Eg. Spouse, parent, sibling. Additional Information or Special Requirements * Please share any accessibility needs, dietary requirements for events, or other information we should know. CONSENT & AGREEMENTS Required Consent * I consent to my information being used for program administration and communication purposes. Optional Updates I would like to receive updates about future professional development opportunities. Thank you!
