Banksia Gardens Ambassadors Project - Expression of Interest form -

FOR PEOPLE WITH A DISABILITY

Thank you for your interest in becoming an Ambassador! Ambassadors will be sharing personal stories of transitioning into work, study, training, volunteering or community participation. We aim to inspire and inform audiences with personal presentations and with information gathered from the Ambassadors' experiences. Please take time to complete this Expression of Interest form by July 12th 2013. You are always welcome to contact Rachel or Tash for any help or to arrange a meeting at Banksia Gardens to apply Call: 03 9309 8531 or Email: rachel.w@banksiagardens.org.au

Please note: We are only accepting Ambassadors under the age of 35.

Name Age.. Address. Phone. Email

1. Are you Employed circle)

Studying or Training

Volunteering (Please

2. Where are you employed/studying/volunteering?

3. How long have you been employed/studying/volunteering?

4. Has work/study/volunteering been a positive experience for you? If yes, why? If not, why?

5. What are your hobbies and interests?

6. Why are you interested in becoming an Ambassador?

7. Have you ever had any public speaking experience?

8. Will you be comfortable (happy) to present your personal story to an audience and on video?

9. What activities, people or experiences have helped you on your journey to work/study/volunteering?

10. Are you or were you registered with a job agency? If so, which one?

11. Are you able to commit to a weekly workshop (Wednesday 6pm - 8pm) for 6 weeks in either July/August (Round 1) or September/October (Round 2)?

12. Would you prefer? (Please Circle) Round 1 - held in Hume Round 2 - held in Moreland Either

13. Where did you hear about the Ambassadors program?

14. Will you require any specific assistance or facility?

Thank you for taking the time to complete this form. Please do one of the following: - Scan and email this form to: rachel.w@banksiagardens.org.au - Post or drop this form in at reception to: Rachel Wood, Banksia Gardens Community Services, 71 81 Pearcedale Parade, Broadmeadows - If you would like assistance completing this form, please call 03 9309 8531 to see Rachel or Tash at Banksia Gardens Community Services