Responsible Travel Scholarship Selection Form (Please answer all questions)
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Title: *
Required
Surname: *
(Family name)
Given name: *
(Christian name)
Street address: *
City, town or suburb: *
State: *
Postcode *
Email address: *
Mobile Phone: *
Date of Birth: *
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Where did you hear about the Responsible Travel Leadership Scholarship? *
(Please tick one or more of the following:)
Do you hold a valid passport and permanent residency in Australia? *
Are you able to obtain visitor/tourist visas for Cambodia and the return to Australia? *
(We want to ensure that you are able to travel to Cambodia and then return to Australia)
If selected I will make myself available to join a Uniting Journey on 1-10 February 2014 and also be prepared to make myself available as a volunteer to lead at least one Uniting Journeys tour in the Uniting Journeys calendar before 2015. *
I have read, understand and agree with the aims and objectives of Uniting Journeys. *
Are you prepared to complete a Police background check? *
Do you have sufficient fitness to walk at least 2.5kms, manage stairs or high vehicle steps and cope with hot weather conditions? *
(There will be walking, stepping in and out of high vehicles and climbing stairs involved in the Cambodia tour. In some circumstances it may be necessary to ask you for a letter from your medical practitioner confirming your fitness to travel.)
18. Do you have any previous experience as a ‘tour’ or ‘group’ or ‘activity’ leader?   *
If You answered YES, please provide some details at 'Other'.
19. Are you comfortable speaking in public or talking to the media about your Uniting Journey?   *
(We would like you to be able to talk to friends, relatives and others in your local community or to your local media about your Uniting Journey.)
20. How might participation in this activity make travel possible for you in ways that might not have otherwise been possible? *
 (Please detail here.):
21. What qualifications, experience or skills do you have that might help you be a responsible travel host or leader?   *
Please detail:
22. Would you be interested, if given the opportunity, to visit any particular Cambodian destinations we may be able to identify to link with your skills and experience? *
23. What ‘online’ (computer) skills have you developed that might help you communicate your Uniting Journey experience to others? *
Please detail:
24. Do you belong to any communities (including online) such as a church , service club, sports group or social group through which you could promote the principles of responsible travel? *
If ‘YES’ please detail, using a semi-colon between the different organisations if you list more than one. (under 'Other')  
25. Please provide contact details for three relevant character references: *
(Please details as i), ii) and iii)
26. I understand that the organisers’ decision will be final and no correspondence will be entered into regarding the selection process, or its outcomes. *
Thank you for applying.  We hope you are successful. As we are expecting a reasonable number of applicants for our program we will update you by 1 December 2013 with the progress of our selection process. We hope to complete the selection process and notify the successful applicants by mid-December 2013. Please note that once selected if you withdraw from the 1 February tour it will not be possible to transfer your selection to any alternate tour.
(If you have any urgent enquiry please do not hesitate to contact Jim Wakelam on his mobile: 0403 264 124 or via his email adress: Jim.Wakelam@victas.uca.org.au and he will get back to you as soon as possible)
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