Apply for membership on the Boroondara Arts Advisory Committee 1Introduction2Applicant Details3Key Criteria4 Referee details5 Privacy You can use this form to: Submit an application for membership on the Boroondara Arts Advisory Committee Before you begin: It takes about 10-15 minutes to complete this form and you will need to: Tell us your name, phone number, email and address Provide two referees, including name and contact details Before completing this form please ensure you have read the Boroondara Arts Advisory Committee Terms of Reference Read and accept the City of Boroondara Privacy Statement After you complete this form we: May contact you about your nomination, if required. What happens with your information? We record your information on our customer databases and make it available to relevant Council staff in line with our Privacy Policy Further information or assistance We can provide support in the application for people with disabilities or if you have other access needs please contact us via email arts@boroondara.vic.gov.au or phone (03) 9278 4770 Applicant DetailsName * Required Given name Family name Address * Required Street address or PO Box Address line 2 Suburb / City State Post code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email * Required Phone * Required What is your connection to Boroondara? * Required I live in the City of Boroondara I study in the City of Boroondara I work in the City of Boroondara Other (please describe) OtherDo you currently have any association with the Boroondara City Council? * Required Yes No If Yes, please provide details * RequiredPlease share an example of your commitment to the support and development of arts in the community. (Max 250 words) * RequiredPlease outline your qualifications, skills, knowledge and experience in the arts, culture or heritage disciplines. (Max 250 words) * RequiredExplain how your expertise can support the role and function of the Committee. (Max 250 words) * RequiredWhich category best describes the expertise and knowledge you can bring to the Committee? (Select as many as appropriate) * Required Professional knowledge and expertise Local knowledge and expertise Which arts discipline best describes the expertise and knowledge you can bring to the Committee? (Select as many as appropriate and provide details) * Required Visual arts Performing arts Literary arts History Other Visual arts details Performing arts details Literary arts details History details Other details Are you currently or have you been a member of a Boroondara City Council advisory committee? * Required Yes No If Yes, please provide details * Required Referee details 7.Please provide two referees: First referee name * Required Given name Family name First referee phone * RequiredFirst referee job title: * Required Type of reference: * Required For example, personal, professional etc. Second reference detailsSecond referee name: * Required Given name Family name Second referee phone: * RequiredSecond referee job title: * Required Type of reference: * RequiredFor example personal, professional etc. Name of signatory * Required I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. * Required Yes Terms of Reference * Required I have read and understood the Boroondara Arts Advisory Committee Terms of Reference. Privacy statement * Required I have read and accept Council's Privacy Policy and understand how my information will be used. NameThis field is for validation purposes and should be left unchanged.
