Catalyst Leadership Program
2 August 2017 – 23 March 2018
Personal/Appointment Details
Staff ID Number: / Title (eg Dr, Ms, etc.):Family Name:
Given Name: / Preferred Given Name:School/Section: / Mail Bag Number:
Position Title:
Telephone Number: / Email Address:Employment commencement date at UWA
Academic Level of Appointment and type (tenured or contract)
Length of Contract at UWA (if on contract, please indicate contract end date):
Part-Time/Full-Time Status (if part-time, please indicate FTE e.g. 0.5):
Please provide a brief summary of your employment history at UWA.
Please provide a brief summary of your publication history at UWA. Ensure your attached CV includes publications and writing in progress.
I confirm that I am able to participate in all of the Catalyst Leadership Program workshops and activities.
WORKSHOP / DATESSetting up (half day) 9-12.30pm / 2 August 2017
Module 1 – Leading Self 9-5pm / 5 September 2017
360 Degree feedback (half day) 1-4.30pm / 5 October 2017
Module 2 – Leading Teams 9-5pm / 8 November 2017
Module 3 – Leading Externals 9-5pm / 8 February 2018
Closing out (half day) 9-1.30pm / 23 March 2018
ACTIVITIES
Assessment and Report / Reflective journal, 360 Assessment, self-assessments
Online Community / Activities and discussion, program evaluation
Application / Action Learning project and presentation
Support / Mentor meetings
Signature of Applicant / Date
Note: To be eligible for the Catalyst Leadership program, you must have a UWA contract that runs until at least June 2018. If your present contract expires before this date, please provide an additional letter of support from your supervisor/head of school indicating that your contract is expected to be renewed.
To be completed by the Supervisor:
I confirm that support will be provided to enable this applicant to participate fully in the Catalyst Leadership Program:
Name of Supervisor/Head of School(Please Print) / Signature of Supervisor/Head of School / Date
Return by Friday 30 June 2017 to Lucienne Tessens, HR (M350) or