ࡱ> SUR%` ,bjbjٕ 8< f8L$Z q+6::::MT?,*******$_,h.@*]OIMOO*::++)))O4::*)O*))r<)T*:* `Ls)*A+0q+)z//*/*k")kkk**kkkq+OOOOZ Z Z  ^$Z Z Z ^&$Jb The South Australian Rural Leadership Program CONFIDENTIAL APPLICATION FORM INSTRUCTIONS Please complete each section in full. This electronic form contains fields for your entry. Click in the field to type your response or select from the dropdown list that appears. One letter of recommendation will be accepted. PERSONAL DATA Title  FORMDROPDOWN  Surname  FORMTEXT       First name  FORMTEXT       Middle name  FORMTEXT       Preferred name (or name tag)  FORMTEXT       Date of birth  FORMTEXT       Postal address  FORMTEXT       Town  FORMTEXT       Post code  FORMTEXT       Home ph  FORMTEXT       Work ph  FORMTEXT       Email  FORMTEXT       Home fax  FORMTEXT       Work fax  FORMTEXT       EDUCATION Secondary  FORMTEXT       Tertiary  FORMTEXT       Other  FORMTEXT       RURAL LEADERSHIP Describe what you believe are the major issues facing rural South Australia today and in the future.  FORMTEXT       INDUSTRY/COMMUNITY INVOLVEMENT Please list what you consider to be your best achievement in community work, career, industry involvement, education, etc.  FORMTEXT       MOTIVATION Please describe why you are interested in attending the South Australian Rural Leadership Program.  FORMTEXT       CURRENT ACTIVITIES Please list the community/industry/social groups in which you participate and at what level.  FORMTEXT       FUTURE ACTIVITIES Please describe how, in the future, you may use the skills and knowledge obtained from the South Australian Rural Leadership Program.  FORMTEXT       OCCUPATION What industry sector are you involved in? Are-.XY}~ : ; N O P ^ _ ` a i j t u $ & : < > H J L b d f z | ~ ѻճܨճ܏Ջ܀ճujh+0eUjh+0eUh&9jh+0eUjh+0eUmHnHujh+0eUjh+0eUjhVh+0eUjhVUhV hnhth+0e h+0eha hNkh  hNkhNk h~'hnha..Y ; I  2 x V  N gd+0egdV gd+0e gd+0e gdA(JgdzgdVgdz,, " $ . 0 P R f h j t v      , . 0 D F H R T b d x ֵ֢֗ֈjh+0eUhVjTh+0eUjh+0eUhVCJ aJ jhh+0eUjh+0eUj|h+0eUh+0e hnhthVCJ aJ jh+0eUmHnHujh+0eU5x z |  & ( < > @ J L ` b v x z tvӹײӧӜӑ썆ha hKhKhQjh+0eUjh+0eUjh+0eU hKhtj,h+0eUhVjh+0eUh+0e hnhtjh+0eUmHnHujh+0eUj@h+0eU0&j(*,  ",.0&(*468dhj~"D"F"b"ȽжȫȠжȕГЋhVjhVUUj h+0eUjf h+0eUjh+0eU hahajzh+0eUh+0eha hKhK hKh+0ejh+0eUmHnHujh+0eUjh+0eU0,B0V8\hh""""#.#@####6$$$%>%gda gdVgdVgdVgd+0e you a bonefide primary producer?  FORMDROPDOWN   FORMTEXT       Current Employment  FORMTEXT       Previous Employment  FORMTEXT       REFEREES Please provide the name of two referees. Name  FORMTEXT       Position  FORMTEXT       Address  FORMTEXT       Phone  FORMTEXT       Fax  FORMTEXT       Name  FORMTEXT       Position  FORMTEXT       Address  FORMTEXT       Phone  FORMTEXT       Fax  FORMTEXT       How did you find out about the South Australian Rural Leadership Program? Newspaper  FORMCHECKBOX  Radio  FORMCHECKBOX  Drought e-news  FORMCHECKBOX  PIRSA website  FORMCHECKBOX  Other  FORMCHECKBOX  (Please specify)  FORMTEXT       Please attach any additional supporting information if necessary. I understand and support the vision and goals of the South Australian Rural Leadership Program. If selected: I agree to commit myself to these goals and will continue to apply this knowledge to my community/industry. Current fees sheet available from Rural Affairs. Applicant signature  FORMTEXT       Date  FORMTEXT       Please email completed applications to: Ms Lib Hylton Keele SARLP, Rural Affairs, Primary Industries and Resources SA Email:  HYPERLINK "mailto:hyltonkeele.lib@saugov.sa.gov.au" hyltonkeele.lib@saugov.sa.gov.au Any questions please call Lib on (08) 8226 0245     b"d"f"h"j"~"""""""""""""""#### #*#,#.#>#v############ڽڶ֧ڽڶ֜ڽڶ{mf hVhVjhVUmHnHujB hVU hVh$#hA(J h$#h$#haj h+0eUjV h+0eUhV hKh+0ejh+0eUmHnHuj h+0eUh+0ejh+0eU hKhKjhVUjR hVh+0eU(##########$$$$&$($2$4$6$B$D$X$Z$\$f$h$j$p$r$t$$$$$$$$$$$$$$$$$$$$%%%%,%.%j|hVUjhVUjhVUjh+0eUj h+0eUj. hVU hVhVjhVUmHnHuj hVUhVjhVUh hVh$#5.%0%:%<%J%L%`%b%d%n%p%r%z%|%%%%%%%%2&H&J&L&h&j&l&x&z&|&&&&&&&&&&&&&&''','.'J'ޯޤޙޒއj:h+0eU h$#hVjh+0eUjRh+0eUjh+0eU haha h$#h$#jhhVUjhVUhV hVhVjhVUmHnHujhVU1>%%6& ''(()4**+.++d,,,,,,,,,, gd&9gdagd+0egdagdagdV  gdVgdV gdVJ'L'N'r't''''''T(X(n(((((())))2*4*\*^*r*t*v*************+ +,+>++++ⲽjh+0eUjh+0eUmHnHujh+0eUjh+0eU h$#hah$# hahahah+0ejhVUmHnHuj"h+0eUhV h$#h$#jhVUjhVhVU/++,, ,`,b,,,,,,,,,,,,,hahjhU h$#h$#h$#h+0eh$#0J^Jjh+0eh$#U h+0eh$#jh+0eh$#U,,,gd+0e6&P 1h:pz. 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