CESPHN Clinical and Community Councils 2027: Expressions of Interest Form

Please use this form to submit an Expression of Interest in CESPHN's Clinical or Community Council for 2027. Applications close on 30 October.

Are you an existing CESPHN Council member?

YesNo

I currently live or work in the area covered by CESPHN

*Applicants must live or work in the area covered by CESPHN in order to be eligible

The Clinical Council comprises of health professionals, including a combination of those working within primary care (GPs, practice nurses, practice managers, allied health professionals) and others with strong experience in primary care.

The Community Council comprises community representatives, and those working in community services with strong experience and understanding of the intersection of primary care and the community.

Which Council are you applying for?

Clinical CouncilCommunity Council

Are you a

Community Service representativeCommunity Member

Which community service do you represent?

Your Details

First Name

Last Name

Email Address

Contact Number

Gender

Your Address

Number and Street Name

Suburb

State

Postcode

Do you identify as a member of any of these groups?

Person with a disabilityAboriginal and/or Torres Strait Islander personCulturally and Linguistically Diverse (CALD)N/A

Is there any further information you would like to provide?

Qualifications and Expertise

Applicants must demonstrate:

Strong understanding of the needs of the community
extensive networks across their profession
ability to engage constructively in a committee environment.

What is your area of clinical expertise?

Please upload your CV

Please outline your interest in joining this Council and describe the issues you think the Council should be addressing in 2027. (200 words)

Please outline your contributions to the Council in the last term. (200 words)

Please declare any interests, including potential and perceived, that may be related to your appointment on the Council

Declaration

By submitting this form to CESPHN, you hereby agree:

The information I have provided in this application is correct at the date of submission.

If successful, I will apply to be a member on one of CESPHN's member organisations. 

I will formally advise CESPHN of any significant changes in circumstances that may affect the accuracy of this declaration.

The PHN reserves the right to invite and remove members of the Council from time-to-time but will seek advice from Council members before doing so.

I agree with the above statement

Please upload your CV

What is your full name?

Thank you for your interest in joining the Community Council as a community member.

Please upload your CV and provide a brief description of why you would like to join, and a member of the team will be in touch.

Thank you for your interest in rejoining the Community Council as a community member.

Please upload your CV and provide a short explanation of your contributions to the Community Council this year.