Victorian Committee for Families of Children with Disability Application Form

Campaign ID

Contact ID

Campaign Member Status

For help with the application please call 9880 7000 or email policy@acd.org.au

Your details

First Name

Last Name

Mobile

e.g. +614########

Email Address

Your Date of Birth (DD/MM/YYYY)

Address information

Street Address

Suburb

State

Postcode

Are you the parent/carer of a child with a disability?

YesNo

This is a mandatory requirement for the position.

Tell us about you

The next questions are about you. You can answer these questions in dot points.

If you need help with the application, please contact call 9880 7000 or email policy@acd.org.au

What is your motivation for becoming a Committee Member? (400 words max.)

What are the key issues you see for families with children with disability? (400 words max.)

What life experiences do you bring that will be important for the Committee? (400 words max.)

If you were successful, are there any areas you’d like additional training in to support your confidence and engagement? (400 words max.)

If you are in paid employment, what is your position title and organisation?

More details

Are you currently on any other advisory groups, either as an individual or representative of an organisation?

YesNoPrefer not to say

Which advisory groups?

Will you be able to attend one meeting per year in Melbourne?

YesNoUnsure

Do you have access to a tablet/computer for online meetings?

YesNoUnsure

· Do you have any accessibility requirements to support your participation in meetings? (If yes, please provide more details)

· Is there anything else you would like to tell us? (max 300 words)