Download Expression of Interest Form to Become a Member of a Victorian

HIGHER EDUCATION AND SKILLS GROUP:
EXPRESSION OF INTEREST FOR A UNIVERSITY
COUNCIL ‘APPOINTED MEMBER’ VACANCY
1. Council(s) that you wish to
be considered for:
(tick if lodging a hard copy or bold
the required names for an electronic
return)
2. Would you be willing to
serve on a TAFE board?
3. Name (current):
Ballarat
Deakin
Latrobe
Melbourne
Monash
RMIT
Swinburne
Victoria
□ Yes
□ No
If yes, please indicate which TAFEs in order of
preference:
1.
2.
3.
Surname (Family name): Other names:
4. Any previous name:
5. Your Title:
Ms
6. Date of birth:
Gender:
……/……/……..
Mrs
 Female
Mr
Dr. Other (Please specify)
Country of birth:
 Male
7. Preferred address for
correspondence:
8. Residential status:
 Australian citizen
 Australian resident
Other (please specify)
9. Telephone Nos:
(Please insert and  or bold your
preferred contact no.)
 Work:
 Home:
10. Fax Nos:
 Mobile:
Work:
(if applicable. Please insert and 
or bold your preferred contact no.)
 Home:
11. Preferred email:
Other email (if applicable)
12. Language(s) other than
English spoken at home:
If you are an
Indigenous Australian:(please tick here)

13. Academic and/or
educational qualifications:
(please list the most recent first by
year, title, and institution).
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HIGHER EDUCATION AND SKILLS GROUP:
EXPRESSION OF INTEREST FOR A UNIVERSITY
COUNCIL ‘APPOINTED MEMBER’ VACANCY
14. Relevant unaccredited
training or professional
development courses:
(please list by year, title and
provider).
15. List membership of any
professional
bodies/organisations:
16. Current occupation and
employer(s):
(if relevant).
17. Experience and/or
knowledge of education
and/or training:
18. Please list your main qualities that you consider most relevant to this
application:
[Note: You may also attach a personal resume].
19. Please list your current membership or experience of any relevant
community, educational, or business organisations, etc.:
20. What specific kinds of knowledge and skills would you bring to the role?
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HIGHER EDUCATION AND SKILLS GROUP:
EXPRESSION OF INTEREST FOR A UNIVERSITY
COUNCIL ‘APPOINTED MEMBER’ VACANCY
Please note:
1.
Employees and students of a university are not eligible for Governor in Council
appointments to that university council.
2.
A person is not eligible for appointment to a council if they are of unsound mind
or a person whose person or estate is liable to be dealt with in any way under
the law relating to mental health, or is bankrupt, or has been convicted of any
indictable offence.
3.
The information provided by you will be held for one year by Higher Education
and Skills’ Tertiary Education Governance Unit. It will not be held confidentially,
in that it may be provided on request to public university council
representatives.
4.
Higher Education and Skills’ Tertiary Education Governance and Planning Branch
may approach any person or body for the purposes of verifying any candidate
information given in this application.
I hereby declare that I am a fit and proper person to be a member of council of a
Victorian public university and that I acknowledge that the information contained in
this form is true and complete.
Signature: ________________________________
Date: ___/___/___
Please post your completed expression of interest form and any attachments to:
Tertiary Education Governance Unit
Tertiary Education Governance and Planning
Higher Education and Skills Group
Department of Education and Early Childhood Development
GPO Box 266
MELBOURNE VIC 3001
or email the form with any scanned attachments to:
[email protected]
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