Expression of Interest Form

The Brimbank Aboriginal and Torres Strait Islander Consultative Committee will comprise of seven (7) members. Membership will include up to four (4) Aboriginal and/or Torres Strait Islander representatives and up to two (2) general community members with a demonstrated commitment to Reconciliation. The membership will be reviewed after two (2) years.

1. Personal Details

Name: ________________________________________________________

Gender: (Please circle) Male Female Other Date of Birth: __________

Address: Street:___________________________________________________

Suburb:______________________________ Postcode: _________

Best contact phone number: ____________________ SMS: YES / NO

(please circle)

Email: _________________________________________________________

2. Country of birth: ____________________________________

3. Are you of Aboriginal or Torres Strait Islander origin?

 No  Yes, Aboriginal

 Yes, Torres Strait Islander

(For persons of both Aboriginal and Torres Strait Islander origin, mark both ’yes’ boxes.)

4. Relationship to Municipality

Do you have a relationship to Brimbank? If so, please indicate the nature to that relationship.

◻ Resident (District) ……………………………………………..………………………....……….......

◻ Work (Please provide details)………………….……………………………………..……….......

◻ Other (Please provide details)…………………………………….…………………..……….......

Please answer the following questions about why you would like to apply to become a Community Consultative Committee member.

1. Are you applying as:

 An Aboriginal and/or Torres Strait Islander representative

 A general community member

2. Please explain what knowledge, skills and experience you would bring to the Brimbank Aboriginal and Torres Strait Islander Consultative Committee? (please feel free to attach a CV if relevant)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Please explain why you are interested in being on the Brimbank Aboriginal and Torres Strait Islander Consultative Committee?

4. What is your understanding of issues that affect the local Aboriginal and Torres Strait Islander community?

5. Are you able to work within the Terms of Reference? _________________

6. Do you have any experience participating as a member of a Committee or Board? If so, please provide details.

7. Please provide any additional information that you feel would be relevant for consideration.

Please name one referee from the community we may contact by phone or email.

Name: ________________________________________________________

Contact Number: ________________________________________________

Email: _________________________________________________________

By signing you certify that the information provided above is true and correct:

Signed: Date:

Your information will be stored in accordance with Brimbank City Council’s Privacy Policy available at: http://www.brimbank.vic.gov.au/COUNCIL/Governance/Information_and_Health_Privacy

Please return Expression of Interest form by the 14 March 2025 to:

Email: Reconciliation@brimbank.vic.gov.au

Postal Address: PO Box 70, Sunshine VIC 3020