Claisebrook Cove Community Reference Group (CCCRG) – Application Form

Thank you for your interest in joining the Claisebrook Cove Community Reference Group (CCCRG). Please complete the form below to express your interest in participating. Applications close 5pm 22 October 2025.

Full Name:

* required

Maximum 255 characters

0/255

Residential or Business Address:

* required

Maximum 255 characters

0/255

Phone Number:

* required

Maximum 255 characters

0/255

Email Address:

* required

Cohort Representation
Please select one cohort that best represents you

* required

Local Resident of Claisebrook

Local Business Representative of Claisebrook

Parent with Children

Student residing in Claisebrook (e.g. local school, TAFE, university)

Other Interested Party (e.g. local worker, visitor, environment group, local resident outside of Claisebrook) – Please state below:

Motivation for Joining
Why do you want to be involved in the CCCRG?
(Please briefly describe your interest and what you hope to contribute)

* required

Declaration

* required

I confirm that I have read and understood the Terms of Reference for the Claisebrook Cove Community Reference Group (CCCRG).

I agree

I agree to comply with the expectations and responsibilities outlined in the Terms of Reference.

I agree

I understand that if more applications are received than places available for my selected cohort, selection will be made by random ballot.

I agree