CASE STUDY COVER SHEET (INDIVIDUAL CASE STUDIES)
PROJECT:
Promoting CALD Women’s Participation on Boards and in Decision-Making Positions
Information from the Demographic Survey may be circulated as part of the final project report to
the Office for Women. Private information will be treated in accordance with the Privacy Act 1988.
You may withdraw your consent to disclose information at any time throughout the project
period.
Please forward completed survey by Wednesday 1st May 2013 to either:
Post:
Email (preferred):
CALD Women’s Leadership Project
Subject line: CALD Women’s Leadership – case
study (individual)
MyriaD Consultants
PO Box 439
Altona 3018
VICTORIA
Contact Details
Full Name:
Contact number:
Contact Email:
Current position title:
Organisation:
State / Territory of
Residence:
Personal Information
Country of birth:
If not born in Australia, please
indicate number of years in
Australia:
[email protected]
Ethnicity:
Languages spoken:
Citizenship:
Work Experience
Please tick the categories that most reflect your expertise or most recent work
experience. Those categories ticked need to relate to the information you provide in the
next section.
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Aboriginal & Torres Strait Islander Affairs
Accounting / Finance / Economics/Banking
Administration / Management / Consultancy
Advertising/Public Relations
Aged
Architecture / Urban Planning
Arts / Culture
Business / Small Business Owner
Building / Construction/ Engineering
Chiropractor / Osteopath / Physiotherapist
Community Services / Welfare / Care
Communications / Media / Marketing
Conservation / Environment / Energy
Consumer Affairs
Dentistry
Designer / Graphics
Education (Primary; Secondary; Tertiary; Adult; Vocational)
Emergency (Fire, Ambulance)
Health / Nursing / Hospitals / General Practitioner
Health Promotion
Hospitality/Tourism
Housing / Accommodation / Real Estate
Human Resources
Human Rights / Advocacy
Industrial Relations / Trade Unions
Information Technology / Computing
Industry / Trade / Manufacturing
Insurance
Law
Occupational Health & Safety
Police/ Corrective Services / Security
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Racing/ Gambling
Science
Social Worker/Psychologist/Psychiatrist/Counsellor
Sport/Recreation
Transport
Veterinarian/Animals/Wildlife
Youth
Other ………….………………….
Professional and Personal Skills and Experience
Please provide brief details of relevant professional and personal skills and experiences.
(If there is insufficient space to provide enough information please attach further information on
additional pages).
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Academic / professional qualification completed or ongoing. (if applicable)
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Description of your current board appointments / decision-making position.
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Description of previous board appointments / decision-making position.
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Strengths / skills / life experiences that you bring to this position / these positions as
a CALD woman.
OPTIONAL CONSENTS
Please indicate if you authorise the reproduction of the information you have provided for
inclusion in the Project report.
• Yes
• No
I certify that the information contained on this form and any additional information provided is
true and correct.
Signature:…………………………………………………………………………………
Date: ………………………………………………………………………………………..
For further information about the Project, please contact the research team:
Maria Dimopoulos
Georgia Prattis
P: 03 9315 0902
M: 0410 507 782
E: [email protected]
Information is also available on the FECCA website at - www.fecca.org.au
We recognise the rich diversity of women across the broadest spectrum - including age, ethnicity,
ability, sexual orientation and geographic location. As such, we strive to adopt an inclusive
approach to our data collection processes.
The Project Team is committed to making its information, events and venues, accessible to as
many people as possible.
 If you have difficulty reading a standard printed document and would like to receive this
publication in an alternative format—such as large print or audio—please telephone the
Project Research Team on (03) 9315 0902.
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If you are deaf or hearing impaired and required the TTY typewriter service—please
contact the research team at [email protected]
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Cover sheet - individual case studies