CHIEF EXECUTIVES STUDENT FORUM

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					                   DEPARTMENT OF
                   EDUCATION AND TRAINING
                                  CHIEF EXECUTIVE’S STUDENT FORUM
                                       Student Application Form 2010
 First Name:                                                      Preferred Name:

 Last Name:

 Date of Birth:         /    /       Gender:     M          F               Age:               Year Level:

 Home Address:
                                                                                             Postcode:

 In which country were you born?



 Do you speak any languages other than English?



 Are you of Aboriginal or Torres Strait Islander descent?                                Yes                 No


 Are you a member of Indigenous Students’ Leadership & Mentorship Program?               Yes                 No


 Name of school:

 School address:

 School phone number:

 Your application will need the support of two referees. One referee must be from your school and the other must be
 from a community member such as your employer, sporting coach, family friend etc. Both referees must fill in the
 attached Referee Report (see page 5).

 Name of school referee:

 Relationship to you:

 Contact phone number:

 Email address:


 Name of community referee:

 Relationship to you:

 Contact phone no:

 Email address:


Chief Executive’s Student Forum
Student Application Form
Page 1 of 6
             DEPARTMENT OF EDUCATION AND TRAINING

 Provide details of any extra-curricular or community activities, programs, events or organisations that you have
 recently been involved in, such as sporting club memberships, musical performances, casual employment, volunteer
 work etc.

     Name of activity, program, event or organisation                                Your role




 Outline three key issues in education that you would like to discuss during the forums. Ensure you are specific, and
 explain clearly how each issue affects you or your peers.
 1




 2




 3




 Outline three key ideas that you have to improve education for yourself and your peers. Ensure you outline each idea
 clearly and specify which aspect of your education would be improved.
 1




 2




 3




Chief Executive’s Student Forum
Student Application Form
Page 2 of 6
             DEPARTMENT OF EDUCATION AND TRAINING




 Who will you consult to gather a range of views to bring to each student forum? How will you do this?




 How will you report back on the progress of each student forum to your peers at school?




 Give some examples of how you have worked as part of a team.




 What qualities or skills could you bring to the Chief Executive’s Student Forum?




 What do you hope to gain from participating in the Chief Executive’s Student Forum?




Chief Executive’s Student Forum
Student Application Form
Page 3 of 6
             DEPARTMENT OF EDUCATION AND TRAINING

 Your application will need to be signed by your parent or guardian and the principal of your school. You also need to
 confirm that everything you have written in this application is truthful.


 Student

 I ………………………………………………… (your name) confirm that the information in this application is true and correct to
 the best of my knowledge.
 Signature                                                     Date        /      /




 Parent

 I ………………………………………………… (name of parent or guardian) confirm that the information in this application is
 true and correct to the best of my knowledge.
 Signature                                                     Date        /      /


 Principal
 I ………………………………………………… (name of principal) confirm that the information in this application is true and
 correct to the best of my knowledge and that this application is endorsed by

 …………………………………………………………(name of school).
 Signature                                                     Date        /      /




  Please return applications by Friday 26 February 2010 to:
  Fax: 8999 4200
  Project Coordinator, Chief Executive’s Student Forum
  Curriculum, Teaching and Phases of Learning
  Department of Education and Training
  Level 1 Harbour View Plaza
  DARWIN NT 0800




Chief Executive’s Student Forum
Student Application Form
Page 4 of 6
             DEPARTMENT OF EDUCATION AND TRAINING


                                  CHIEF EXECUTIVE’S STUDENT FORUM
                                         School Referee Report

 Name of Student:                                             School:
 Name of Referee:                                             Position:
 Phone:                                                       Email:

 How long have you known the student and in what capacity?



 Please provide dot point responses under the following headings.
 Personal qualities and skills that would contribute to the CESF




 Examples of involvement in educational issues




 Involvement in school and community activities




 Ability to consult with other students, to gather and to disseminate information




 Ability to work with others in a team environment




 Ability to present ideas to others




 Any other comments




 Referee’s signature                                                      Date      /   /
Chief Executive’s Student Forum
Student Application Form
Page 5 of 6
             DEPARTMENT OF EDUCATION AND TRAINING


                                      Community Referee Report

 Name of Student:                                             School:
 Name of Referee:                                             Position:
 Phone:                                                       Email:

 How long have you known the student and in what capacity?



 Please provide dot point responses under the following headings.
 Personal qualities and skills that would contribute to the CESF




 Examples of involvement in educational issues.




 Involvement in school and community activities




 Ability to consult with other students, to gather and to disseminate information.




 Ability to work with others in a team environment




 Ability to present ideas to others




 Any other comments




 Referee’s signature                                                      Date       /   /


Chief Executive’s Student Forum
Student Application Form
Page 6 of 6

				
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