More information required Ambassador Application Please complete this form so that we can progress your application to be an Ambassador: Step 1 of 4 25% Your name* First Last Your email* Phone*Gender* Female Male Would rather not say Best POSTAL ADDRESS* Street Address Address Line 2 City State Post Code Please ensure you check this address as we will ship resources to you.Do you identify as:* Aboriginal Torres Strait Islander Both Aboriginal and Torres Strait Islander None of the above Prefer not to say Name of organisation/centre/company you work for:*Current job title:*What Queensland Region would you like to be an Ambassador for?*South East Queensland: BrisbaneFar North QueenslandMackayIsaac and WhitsundaysCentral QueenslandCentral West QueenslandWide Bay BurnettDarling Downs and South WestSouth East Queensland: Sunshine CoastSouth East Queensland: Gold CoastAre you a representative of a political party?* No Yes CRQ will include a bio next to your name on our website. Please detail what you would like that bio to say below. Perhaps include information about the region you live in, what you do for work, why you belive it's important to advocate for children's rights and a fun fact about you. MAXIMUM 100 WORDS*By completing this field you agree that this information may be tweaked and placed on the Children's Rights Queensland website.If you would like to include an updated picture of yourself with your bio please attach it here.Max. file size: 50 MB.By uploading an image you give permission for it to be published on the Children's Rights Queensland website.Blue Card/Teacher Registration Number DetailsChildren's Rights Queensland takes child protection very seriously and it is a requirement that all Ambassador Applicants provide their Blue Card details or Teacher Registration number for verification online.Please indicate which of the following applies to you:* I have a Blue Card I have a Teacher Registration Number Name on Blue Card:*Blue Card Number: Format as #####/#*Expiry Date* MM slash DD slash YYYY Teacher Registration Number*You can check your details here: https://www.qct.edu.au/registersearchHave you ever been convicted of a criminal offence?* Yes No Is there anything we can do to support you in this role? Do you require any specific resources?I agree to comply with the Ambassador Code of Conduct and I agree to the organisation Privacy Policy available on the CRQ website.* I agree Click here to view the Ambassador Code of ConductCAPTCHA
