Community Advisory Council

Personal Details

First Name *

Surname *

Street Address *Street Address Line 2

Suburb *

State *

Postcode *

Country

Phone Number *

Email *

General Experience

It is mandatory that individuals have at least two of the general experience skills listed below to progress. Please select the skills that match your experience.

Strong community linkages and networks within the CCQ footprintSkills, experience and knowledge in community engagement, consumer participation or community empowermentRelevant personal or professional experience in health, community, business, advocacy or governance roles

Please provide further details about your general experiences above *

What appeals to you about this role? *

How will your experience be relevant and useful to the purpose of the CAC? *

How confident are you in representing the needs and views of others as well as your own? *

What sort of teams or committees have you been involved in? What was your role? *

Diversity and Equity

Gender *

MaleFemaleNon-binary/otherChoose not to answer

Age *

15-2425-4445-6465 and over

Select locality by sub-region *

Bundaberg/North BurnettGladstoneGympieFraser CoastCentral Highlands/Woorabinda/BananaRockhampton/LivingstoneNoosa to Maroochy RiverBelow Mooloolah River and SC HinterlandMooloolah River to Maroochy River

Do you identify as a member of any of these groups *

Aboriginal and/or Torres Strait Islander People living with disability Culturally and linguistically diverseNo

Referee Details

Referee's First Name *

Referee's Surname *

Referee's Profession *

Organisation *

Referee's Phone Number *

Referee's Email *

Relationship to You *

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