Registration for LeadershipConnect 2025 Form

LeadershipConnect is a six-month, tailored online program of leadership learning, networking and support for Australia Awards scholars and alumni of all genders from the Pacific. Please ensure your eligible for participation before filling out this form.

Title

First Name

Middle Name(s):

Last Name

Preferred Name

Gender

Date of Birth

Country of Birth

Citizenship (If different from country of birth)

Do you have any medical conditions/disabilities that may require additional assistance/support in order to participate in LeadershipConnect 2025?

If yes, please specify

Phone Number

Email Address

Mailing Address (Where you would like hard copy certificate sent)

In order to receive a certificate, you must meet the minimum attendance and participation requirements of the program.

Are you a current or former Australia Awards scholar?

Status

Educational Institution (all applicants)

Course Name (all applicants)

Qualification (all applicants)

Expected Completion Date (or completion date if you are an alumni)

Student Contact Officer - Name (current scholars only)

Student Contact Officer - Email (current scholars only)

Why are you interested to participate in LeadershipConnect 2025?

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What leadership impact you would like to have in your community or country?

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In your opinion, how can women and men work together more effectively to bring about positive development in the Pacific?

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LeadershipConnect 2025 is an online program. Participants are required to attend a 2-hour session via Zoom every Wednesday at the following times: - 12 March – 2 April: 1:00PM – 3:00PM (Australian Eastern Daylight Time) - 9 April – 10 September: 12:00PM – 2:00PM (Australian Eastern Standard Time).

Can you commit to this? Check your timezone here: www.timeanddate.com/worldclock/converter.html

If yes, where will you access your connection?

Please indicate if you require assistance identifying/accessing a venue with internet access in your location?

How did you hear about LeadershipConnect 2025?

Do you consent of having your image and/or participation promoted through WLI and Australia Awards communication channels?

Have you previously applied for, or participated in, other WLI programs/activities?

If yes, please provide further details (year, cohort, event, etc).

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Please include any other information here that you feel is relevant to your application for LeadershipConnect 2025.

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If you are a spouse or partner of a WLI alumni, what is their name and what year did they do the program?

Please only answer if this is relevant.

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