Country to Canberra: Competition 2016Competition Submission Form

Win our 2016 Leadership Competition!At least 10 young women will score an amazing ‘Power Trip’ to Canberra, meet powerful female leaders, connect with mentors, and get your work

published nationally!

Submit your entry to contact@countrytocanberra.com.au by 11pm AEST 9 September 2016

See our website for full Terms and Conditions

Applicant InformationNameGrade and AgeSchoolTown/CommunityState/TerritoryEmail addressContact phone no.Are you of Aboriginal or Torres Strait Islander origin? Yes NoHow did you hear about our competition?

School/Teacher Radio/Newspaper Facebook Twitter Local Organisation Family/Friend Other…………………Would you like to hear about our future opportunities via email? Yes No

Parent/Guardian InformationParent/Guardian #1 nameParent/Guardian #1 email addressParent Guardian #1 contact phone no.Parent/Guardian #1 addressParent/Guardian #2 nameParent/Guardian #2 email addressParent/Guardian #2 contact phone no.

To enter:

Country to Canberra: Competition 2016Competition Submission Form

To win the Power Trip prize, entrants must be:1. Female students who are attending school in grades 10, 11 or 12 in 2016.2. Be 15 years of age by 20 November 2016.3. Attend a school that is located at least 50 kilometres away from a town with a

population 80,000 persons or more.a. For example, if you attend school in Alice Springs (population 28,000), you’re eligible to enter. If you

attend school 30 kilometres out of Newcastle, NSW (population 300,000) then you are ineligible to enter.

See our website for more details, check out our FAQ page or contact our team, we’re here to help!

If you are entering as a 2-minute video or podcast, please email this form as well as your video/podcast file to contact@countrytocanberra.com.au

If you are entering in 400-word written format, type your entry into the form below, and then submit it to contact@countrytocanberra.com.au

Remember, your answer should address the following question:

Why is gender equality important to you and your community?

Answer:

Country to Canberra: Competition 2016Competition Submission Form