Application Form for Professional Development Opportunity with Bleach* Festival 2016
Please read the Guidelines for this opportunity before completing this application form.

Applicant details

Contact details

Title (Mr/Mrs/Ms/Miss/Dr)
Full Name
Residential address
Postal address (if different)
Phone/mobile
Email
Website (if applicable)

Statistical information

Do you identify with any of the following groups? (please select all that apply)

Information in this section is not used to assess your application. Information you provide will be aggregated and used to review access to City of Gold Coast programs.

Aboriginal peoples / People with a disability
Torres Strait Islander peoples / Regional Queenslanders
People from a culturally and linguistically diverse background / Australian South Sea Islander peoples
Young people (13–30 years of age) / General population
Older persons (over 55 years of age) / Other:______
Application information
Describe where you are at in your career/practice now.
Tell us about who you are, what you do and what you are interested in. Be sure to mention any previous involvement in the arts, cultural and creative sectors.
Describe any relevant work experience or education.
Have you managed or helped to coordinate projects or events before? Tell us about that.
Please also attach a CV (4 page maximum).
How do you envisage this opportunity helping you to develop as an arts and cultural worker?
Do you have specific areas of interest/skills you are particularly looking to develop?
If you are currently working or studying, please describe how you will manage any current commitments with this opportunity.
Describe your significant, demonstrated connection to the Gold Coast (ie. resident, work here).
Referees
Please list three professional references. Please include their relevance to this application/professional relationship to you.
Referee 1:
Name:
Phone:
Email:
Relevance to application:
Referee 2:
Name:
Phone:
Email:
Relevance to application:
Referee 3:
Name:
Phone:
Email:
Relevance to application:
Certification
All applicants
I, the undersigned, certify that:
  • I am over 18 years of age.
  • I am a permanent resident or Australian citizen.

  • I have read and agree to bound bythe ‘Guidelines forCity of Gold Coast Professional Development Opportunity with Bleach* Festival 2016’.
  • The statements in this application are true and correct to the best of my knowledge, information and belief.

  • I give permission for City of Gold Coast to forward my application to Bleach* Festival and, if appropriate, additional industry experts for assessment.
  • If this application is successful, I consent to the media and local Councillors being given information about me and my involvement in the program and I understand that I may be contacted directly by them for media interviews.
  • I consent to information about my involvement in this program being published, released or communicatedvia City of Gold Coast and Bleach* Festival channels, including websites, social media, publications and reportsand other communications channels.

Signature: /  / Date: / DD/MM/YYYY
Name in full:
Last updated: 22/12/2015 City of Gold Coast Application Form for opportunity with Bleach* Festival 2016 Page 1 of 4