Changemakers launchpad application form

Changemakers launchpad application form
Jira issue number
SME
Name*

Given nameFamily name
Preferred name
Age*

DayMonthYear
Date
Email*
example@example.com
How do you describe your gender?*
Please specify*
Suburb*
Postcode*
School, university or other educational institution you attend (if applicable)*
What is your connection to the City of Sydney local area?*
Please describe*
Let's get to know you
What parts of your intersectional identity or life experiences would you like to share?*

This could be things like your cultural background, gender, sexuality, disability, language, or anything else that shapes who you are and how you see the world.0/100
What are some causes or issues you’re passionate about?*

0/100
What interests you about civic engagement and community leadership?*

0/100
What’s a positive change you want to see in your community, school or workplace? *

0/100
How can you personally contribute to this change?*

0/100
Why do you want to participate in this program and what do you personally hope to gain from this opportunity?*

0/100
How will you use what you learn in this program to benefit your community?*

0/100
Please tell us how you found out about this opportunity.*

0/100
Is there anything else you would like to tell us?*

0/100
Availability
If successful, I agree to attend all 6 scheduled program sessions:*

April 28 – Launch eventMay 5 – Civic literacy workshopMay 19 – Civic toolkit workshopJune 2 – Diverse voices workshopJune 16 – Civic action inpracticeJune 30 – Connections evening
Do you require any specific support to access or fully participate in the program?*

YesNo
Please describe:*
Privacy protection notice
Purpose of collection: This information is being collected for the purpose of providing a community program (Changemakers launchpad program).

Intended recipients: City of Sydney employees and any approved contractors required to provide this service.

Supply: The supply of this information is voluntary, however by not completing this form participating in the Changemakers launchpad program is not possible.

Access/Correction: Please contact customer service on 02 9265 9333 or at council@cityofsydney.nsw.gov.au to access or correct your personal information.

Storage: Social Programs team at the City of Sydney, located at 456 Kent Street, Sydney NSW 2000, is collecting this information and the City of Sydney will store it securely.

Other uses: The City of Sydney will use this information for the purpose for which it was collected and may use it as necessary for the exercise of other functions or as required by law. Other uses may include:
- contacting you or your emergency contacts, in an emergency, including medical emergency or accident.
- sending you information about related topics, services or events.
- exchanging information with prescribed bodies relating to a child’s or young person’s safety, welfare or wellbeing if an employee suspects a child may be at risk of significant harm. This exchange of information is prescribed under Chapter 16A of the Children and Young Persons (Care and Protection) Act 1998.
- making a child protection report to the Department of Communities and Justice.
For further details on how the City of Sydney manages personal information, please refer to our privacy management plan.
Should be Empty:

Changemakers launchpad application form

Let's get to know you

Availability

Privacy protection notice