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: georgia@myriadconsultants.com.au 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. 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 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). Academic / professional qualification completed or ongoing. (if applicable) Description of your current board appointments / decision-making position. Description of previous board appointments / decision-making position. 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: georgia@myriadconsultants.com.au 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. If you are deaf or hearing impaired and required the TTY typewriter service—please contact the research team at myriad@myriadconsultants.com.au