2018 Trailblazers Application Form
Complete this form and email to abcheywire@abc.net.au
Applications close July 13, 2018
Please complete one application per individual or group.

1. About you
For groups, the main contact person should complete this.
Name:
Address:          Suburb:
State:      

Post Code:

Email:
Phone:

2. Your age
Date of birth:  -

- -

- -

3. What is your project called?

4. What issue does it address? (eg. mental health, racism, youth unemployment)

5. What activities does your project involve? (events, media, workshops etc.)

abc.net.au/trailblazers
1800 26 26 46
abcheywire@abc.net.au

 6. We are taking applications from individuals, and project teams of up to three people. Who are
you applying for?
Just me (individual)
A project team of two people (me and another person)
A project team of three people (me and two other people)

7. What is your role in the project?
I founded it and run it alone
I founded it and run it with others
I run it within an organisation (eg. a council)
I volunteer as part of a project team
I came up with the idea, but others run it
Other (please specify)

8. If you are applying for a project team, please provide details of the other members of your team.

Team member 2
Name:          

Date of birth:  -

- -

- -

Date of birth:  -

- -

- -

Role in project:
Email:
Phone:

Team member 3
Name:          
Role in project:
Email:
Phone:

9. How does it benefit communities in regional Australia? (200 words)

abc.net.au/trailblazers
1800 26 26 46
abcheywire@abc.net.au

 10. Tell us the story of how the project came about and why it matters to you personally. (200 words)

11. What key events or milestones do you have coming up in the next twelve months? Provide details
and dates (if you know them)

12. What stage are you at with the project?
Just an idea at this stage
We’re working on getting it running
It’s already running
It’s established (running for more than a year)

13. Please provide one referee who can vouch for you and your project.
Name:
Position:
Relationship to project:
Phone:        Email:

14. If you have any supporting information about your project (eg. media coverage or social
media pages) provide links.

abc.net.au/trailblazers
1800 26 26 46
abcheywire@abc.net.au

 15. Why do you want to be a Trailblazer? (200 words)

16. Would you (and other members of your group) be available to travel to Canberra between 2
and 8 February 2019 (exact dates TBC)? (Consider whether you would be able to take leave from work or
study within this time frame)
Yes
No
Other (please specify)

17. Any other comments/questions?

18. Submission
I understand and accept the terms and conditions.

Submit

Thanks so much for applying to be a Trailblazer.

Department of Infrastructure
Regional Development and Cities

abc.net.au/trailblazers
1800 26 26 46
abcheywire@abc.net.au