WFE203 Email Marketing -

Application for Mentoring

First Name *

Last Name *

Email *

Phone *

State/Territory *

Postcode *

I confirm that I identify as a woman (including trans, cis and non-binary) *

Yes

Acceptance of terms (safe space) *

Yes

Acceptance of terms (code of conduct) *

Yes

Acceptance of terms (privacy - sharing info with 3rd party) *

Yes

Accessibility requirements (if any)

Underrepresented communities *

LGBTQIA+/non-binary

First Nations

Disability

Young women (18-28)

Culturally and/or racially diverse

Regional, rural, remote

None of the above

I'd rather not say

Electoral Experience *

Run for public office

Volunteered for a political campaign

Volunteered on an issues-based campaign

None of the above

Do you intend to run in the next election? *

If you selected "other", please specify other level(s) of government

Which political party do you most align with? *

How confident would you feel to run for a political office? (1=not at all confident, 7=very confident) *

What program(s) have you previously completed? *

WFE Equip (in person or online)

WFE First Nations workshop

University-led program

Party-led program

Community Leadership Program

Council training Program

Other

If you selected "other", please specify other program(s) completed

What is your local government area/electorate? *

Are you based in a metro or regional area? *

Are you planning to *

nominate as an election candidate

support someone who runs by working on their campaign

not sure

Please outline any experience you may have and what level of government *

Please briefly outline why you want to stand for public office? *

Please describe any previous involvement in formal or informal mentoring relationships you have been a part of *

Is there anything else you would like to tell us about yourself?