Consumer Advisory Committee Expression Of Interest

Consumer Advisory Committee
Expression of Interest

Thank you for your interest in becoming a member of the Centacare Consumer Advisory Committee. We value the opportunity to hear feedback from our clients, families and carers and appreciate your willingness to share your perspectives with us. Participation on this advisory committee is an opportunity to contribute to improved services and support for Centacare clients and the communities we serve.

Before completing this expression of interest form, please ensure that you have read the Terms of Reference available on this page↗️.

If you have any questions, please do not hesitate to contact us (advisorycommittee@bne.centacare.net.au)

Checklist

I have read the Consumer Advisory Committee (Advisory Committee) Terms of Reference *

I understand that the Advisory Committee is formed to provide input and feedback with regard to Centacare programs and services *

I understand that the Advisory Committee represents diversity of people and program within the communities Centacare provided service to *

I understand that I may be required to read material provided to me prior to meetings so I can

effectively participate in Advisory Committee discussions *

I understand that as a member of the Advisory Committee I cannot make comments to the media on behalf of the Advisory Committee or Centacare *

I understand that membership of the Advisory Committee is voluntary and that I will only be reimbursed reasonable expenses incurred in travelling to the meeting *

I acknowledge the obligation to act with integrity, maintain confidentiality and adhere to Centacare’s Code of Conduct and conflict of interest processes *

I understand that to uphold best practice governance, Centacare will conduct background checks on prospective members and I consent to background screening *

Applicant Information

By submitting this application, I agree to the above and to be bound by the Consumer Advisory Committee's Terms of Reference and Centacare policies and procedures.

Full Name *

Signature *

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Date *

Applicant Supporting Information

Which Centacare services have you used? *

Aged CareNDISCommunity ServicesOther

If other, please provide a brief description *

Geographic area *

Which service area/s do your interests lie *

Please outline any skills, experience or capabilities that you believe would benefit the Advisory Committee including previous experience with similar organisations *

Please provide the contact details of one referee, along with a brief description of their relationship to you *

As noted, Centacare is seeking to have diverse representation on the Advisory Committee including age, gender and cultural backgrounds. Please indicate what sections of the community you feel you could represent:

Applicant Personal Details

First Name *

Middle Name

Last Name *

Previous or Alternate Name

Date of Birth *

Mailing Address *

Residential Address *

Mobile Phone *

Work Phone

Email *

Home Phone

Occupation *