Expression of Interest - School Precinct Safety Community Reference Group

Required fields are marked with an asterisk (*).

Your details

Full name *

Residential address *

Postal address (if different)

Phone number *

Email address *

Preferred method of communication *

Email
Phone call

Organisation or community group (if applicable)

Role in organisation or community group (if applicable)

Connection to City of Prospect

Please indicate how you are connected with City of Prospect. * Select all that apply

I live in City of Prospect
I work or operate a business in City of Prospect
I study or volunteer in City of Prospect
I am a parent, carer or family member connected with a local school
I regularly travel through or use a school precinct within City of Prospect
I have another relevant connection – please describe below

Please describe your connection with our local school precincts. *

Why would you like to join the SPSCRG as a community representative? *

Relevant knowledge and experience

Please describe any lived, professional, volunteer or community experience that would help you contribute to discussions about school precinct safety. * This may include experience relating to parking, traffic, walking, cycling, accessibility, road safety, education, behaviour change, community engagement, school operations or neighbourhood amenity.

Availability and commitment

Please identify any actual, potential or perceived conflict of interest that may arise from your participation in the SPSCRG. * Declaring a potential conflict will not automatically exclude an applicant; it assists Council to consider how any conflict could be appropriately managed.

I am not aware of any conflict of interest
I wish to declare a conflict/conflicts of interest (below)

I wish to declare the following:

Accessibility and participation support

Do you require any accessibility adjustment or other reasonable support to participate in the EOI process or, if appointed, in SPSCRG meetings? *

Please provide details (if applicable)

Referee (optional)

Referee name

Organisation/relationship

Phone

Declaration and consent

Declaration By submitting this form, I confirm that: • the information provided in this Expression of Interest is accurate to the best of my knowledge • I consent to City of Prospect collecting and using the information in this form to assess my Expression of Interest and contact me about the selection process • if appointed, I will act respectfully, consider the interests of the broader community and participate in accordance with the SPSCRG Terms of Reference • I understand that appointment is for an initial 12-month term, subject to Council’s review of the Group • I understand that submitting an Expression of Interest does not guarantee me appointment.

Full Name *

I confirm *

Council

Expression of Interest - School Precinct Safety Community Reference Group

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