`ENABLING WOMEN’

A LEADERSHIP PROGRAM FOR WOMEN WITH DISABILITIES

BARWON 2014

APPLICATION FORM

Name:Click here to enter text.
Address: Click here to enter text.
Phone: Click here to enter text.
Mobile:Click here to enter text.
Email address:Click here to enter text.
What are your passions and interests?
Click here to enter text.
Why are you interested in doing this program?
Click here to enter text.
What connections do you have with your community? Some examples may include being a member of a club, church, or even a long term customer at local shops.
Click here to enter text.
What groups have you been part of?
Click here to enter text.
What did you do as a member of these groups?
Click here to enter text.
What support (s) do you need to participate?
Dietary Click here to enter text.
Attendant care Note-Taker Auslan interpreter
Information in alternative formats Click here to enter text.
Other Click here to enter text.
To do the program you need to attend all 4 days and the graduation. The program will run from 10 – 3pm on
  • Wednesday the 22nd & 29th October 2014
  • Wednesday the 5th & 12th of November 2014.
The graduation celebration will be 1.30 – 3pm
  • Wednesday the 19th November 2014.
Are you to come to all of these days?
Click here to enter text.
Will you commit to come to all of them?
Click here to enter text.
Please provide a referee or supporter of your application and their contact details.
Click here to enter text.

For any enquiries please contact Jane Oldfield - Partnerships and leadership Officer on 9286 7807

Applications can be emailed to Jane at or posted to the address below.

The closing date for applications is Monday the 22ndSeptember

Donations can be made through givenow.com.au/wdv

Level 9/255 Bourke St, Melbourne, VIC 3000. |GPO Box 1160, Melbourne, VIC 3001.

T 03 9286 7800 F 03 9663 7955 ABN561 6055 8848