ARLIC NOMINATION FORM 2025

Australian Rugby League Indigenous Council (ARLIC) Nomination for Membership
Section 1:

Nominee Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Nominee identifies as*

AboriginalTorres Strait IslanderBoth
Section 2

Nominee Background and Experience
Current Occupation:*
Relevant Experience: Please provide a brief summary of your experience relevant to the role you are nominating for (e.g. involvement in rugby league, community work, leadership roles, etc.)*
Skills and Expertise: Please list any specific skills or areas of expertise that you bring to the council (e.g., mental health, socio-economic issues impacting Aboriginal and Torres Strait Islander peoples and communities, government policy, etc.). Lived experienced is considered as expertise.*
Section 3:

Statement of Interest
Why do you want to be a member of ARLIC? Please provide a brief statement explaining your motivation for joining ARLIC and how you plan to contribute to its goals and objectives.*
Section 4:

References
Please provide two referees who can attest to the information provided in this nomination. At least one of these referees should be able to speak to the nominee’s Aboriginal and Torres Strait Islander community involvement.
Reference 1:
Full Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Cultural Referee*

YesNo
Reference 2:
Full Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Cultural Referee*

YesNo
Section 5:

Declaration
I declare that the information provided in this nomination form is true and correct to the best of my knowledge. I confirm that I identify as Aboriginal and/or Torres Strait Islander and I am accepted as such by my own community, or the one that I live in.
Full Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Australian Rugby League Indigenous Council (ARLIC) Nomination for Membership

Section 1:

Section 2

Section 3:

Section 4:

Reference 1:

Reference 2:

Section 5: