Application for Executive Fellows Program

Application for Executive Fellows Program

Tasmanian State Service

Application for Consideration

Executive Fellows Program (EFP)

Excellence in management and leadership development

ANZSOG EFP141 | Page

Application for Executive Fellows Program

Please complete this application form and the Personal Statement section
and forward to the State Service Management Office (SSMO).
About you / / / / / /

Name

Home Address

Suburb | State

/

Post Code

Gender

/ / /

Date of Birth

About where you work

Your Agency

Your Division

Your job title

/ Your Level

Your work address

Briefly outline your current role

Your contact details

Phone Numbers / Landline: Mobile:
Your work email
Your postal address

About your sponsor* details

Name
Position
Email
Phone Numbers / Landline: Mobile:
Postal address
*This is the person to whom you report or the person responsible for managing or supporting you in this program

About your financial sponsor* details

Name
Position
Email
Phone Numbers / Landline: Mobile:
Postal address
*This is the person who has the delegation to agree to pay the Agency’s co-contribution of 40% of the total EFP cost of $29,887 – ie $11,955 towards your participation in the program.
About your work and education background (degrees and/or diplomas awarded) /

Please tick

I have 5 years public sector work experience /
Undergraduate Degree /
Postgraduate qualification /
Master Degree /
PhD /
Other
– please specify
How did you hear about the ANZSOG EFP Scholarship?
/ / /

Please specify

DECLARATION

Your sponsor* declaration to support you attending the program

*This is the person to whom you report or the person responsible for managing or supporting you attending this program.

/ I am aware of the commitment required by the applicant to complete all aspects of the program.
/ I believe the applicant is ready to meet the challenges of the program and I am willing to support them by releasing them to attend the face-to-face component of the program at a location determined by ANZSOG.
/ I am aware that the applicant’s Agency will pay 40% of the EFP fee which is $11,955 as a co-contribution towards the total cost of the program.
/ I understand that the State Service Leadership Development Scholarship Fund will cover the remaining 60% of the EFP fee which is $17,932.
/ The total cost of the EFP which is $29,887 and covers the EFP registration fee which includes three weeks of intensive tuition, reading materials, accommodation (including weekends) and most meals.
The Scholarship does not cover flights, ground costs or additional accommodation required outside the teaching dates. These costs are to be met by the applicant’s Agency.

Signature of Sponsor*

/

Date

Your financialsponsor** declaration and agreement to pay the 40% co-contribution fee

**This is the person who has the financial delegation to agree to and contribute the co-contribution required for the participant to undertake the EFP program.

/ I agree that the applicant’s Agency will pay 40% of the EFP fee which is $11,955 as a co-contribution towards the total cost of the program.

Signature of Financial Delegate**

/

Date

Your declaration

To inform myself about the Executive Fellows Programand fully understand the workload and financial commitment required of my Agency to undertake this tertiary-level study program I have:

Please tick
/ visited Australia and New Zealand Schoolof Government and Department of Premier and Cabinet websites and discussed the EFP program with other EFP Scholarship recipients.

I also declare the following:

/ I am ready to undertake a significant program of tertiary level study.
/ I am committed to participating in all aspects of the program, including being available to attend all workshops as detailed on the program timetable and completing all assessment requirements by the due dates.
/ I will provide the SSMO with a profile for their marketing and communicating mediums.
/ I will seek opportunities through SSMO to share my learnings across the State Service.
/ I will provide a current professional profile / CV with my application form.

Signature

/

Date

PLEASE COMPLETE THE PERSONAL STATEMENT INFORMATION

Your Personal Statement / Application

The Personal Statement is designed to help the Review Panel learn more about you and your motivations for undertaking the program and your desired learning outcomes.

Please answer the following questions using a maximum of up to 500 words per question.

Name:

1.What are your reasons/motivation for undertaking this program?

2.What are your long term objectives and desired learning outcomes, and how will the program help you achieve them?

3.How will the program contribute to your leadership development?

4.How will the program contribute to your organisation’s outcomes?

IMPORTANT NOTE:
If your application for a TSS Scholarship is successful, you will be required to complete
an official ANZSOG Application form for the relevant program and submit via
the State Service Management Office.
Next steps
Print the form, have the document signed by your Sponsor, scan it and send to

ANZSOG EFP141 | Page