Growth Clinic Application Form

Part One: Growing Queensland’s Companies Program.

Company Details

Company Name:

ABN:

Phone:

Current Company Revenue (estimate):

Current Number of Full Time Employees:

Is your company an Indigenous business?

Yes

Attendee Details

If you are filling this out on behalf of your CEO or MD, please ensure this section uses their details.

First Name

Last Name

Position Title

Mobile Phone

Is the Attendee of Aboriginal and/or Torres Strait Island origin?

Yes

Your Goals and Expectations

Why are you interested in the Clinic??

What do you expect to achieve as a result of going through this Clinic??

How did you hear about the Australian Centre for Business Growth and this program?

Additional Joint-Director/Co-Founder

If you would like to bring a joint-director/co-founder, i.e another participant, to the program there will be a fee of $2,500 (excl GST).

Would you like to bring an additional team member? By clicking ‘Yes’ you agree to pay the additional fee of $2,500 for your second participant (excl GST).

Yes

No (If no, you may skip ahead to the Company Details For Invoice Purposes section)

Participant 2 Details

Title(required)

First Name(required)

Last Name(required)

Position Title(required)

Email(required)

Mobile Phone(required)

Company Details For Invoice Purposes

Company Name (required)

Title (required)

First Name (required)

Last Name (required)

Position Title (required)

ABN# (required)

Purchase Order # (if applicable)

Business Street Address (required)

City (required)

State (required)

Postcode (required)

Mobile Phone (required)

Landline (required)

Email (required)

Program Fees

The Queensland Government are fully subsidising the Clinics for CEOs/MDs of Queensland-based companies who want to grow and have 5 – 200 employees. The usual cost of the Clinics is $5,000 (excl GST).

Terms and Conditions

If for any reason you need to reschedule a Growth Clinic, please advise us in writing to aucbg@unisa.edu.au at least 15 business days prior to the Program start date, and we will reschedule you to a different Growth Clinic. In the event of a cancellation, access to online tools and resources will be removed.

The prep-work is a compulsory pre-requisite of the program and includes completing online diagnostics and surveys, and providing company information. As the CEO, you agree that you will complete all prep-work by the due date (two weeks before the Growth Clinic). You may not be eligible to attend the Growth Clinic if prep-work is not completed by the due date.

Privacy

Please refer to the Australian Centre for Business Growth’s Information Handling Policy, available, here.

Longitudinal Data Collection

The Australian Centre for Business Growth is collecting longitudinal data on companies in our programs to help determine what accelerates and inhibits business growth. The data collected from every company that participates in any of our programs will be added to our secure database. We will analyse this data, and develop and disseminate articles about the patterns, relationships and commonalities we find across companies in order to help more companies learn to grow. Information shared in this manner will be de-identified and aggregated to ensure the privacy and confidentiality of information about every company is maintained.

The Centre is also tracking and reporting individual company’s revenue, profit, jobs, and export revenue to state government agencies that have underwritten or subsidised their participation in the Centre’s programs. The state agencies want to understand the economic benefits generated by companies that have completed our programs and will use the longitudinal data to inform their own program and policy initiatives related to economic development.

We are creating the first longitudinal database on growth companies in Australia – perhaps the world, so please respond to our Longitudinal Data Collection requests when we contact you in July and August, each year. Thank you in advance for sharing your company data, lessons learned, and strategies for growth so we can help other CEOs quickly learn to recognise challenges, develop appropriate strategies, and accelerate growth.

Disclaimer

To the maximum extent permitted by law, we (and our employees), the Growth Experts and others we engage do not accept any liability for, and you agree to release us, each of the Growth Experts and others we engage (and each of our respective directors, officers and employees) from any claim in relation to any loss, howsoever caused, suffered or incurred by you arising from your attendance at, participation in or use of information obtained by virtue of your attendance at the Program and any liability we, the Growth Experts and others we engage owe to you is limited, to the maximum extent permitted under law, to us providing the service again.

Next Steps

When you have completed this Application Form, please click ‘Submit’. The Australian Centre for Business Growth team will be in contact with you regarding the status of your application. If your application is successful, the Australian Centre for Business Growth team will confirm your Growth Clinic date and send you instructions for completing your program prep-work via our online system. In the meantime, if you have any questions please contact the Australian Centre for Business Growth team via aucbg@unisa.edu.au or phone 08 8302 0484.

By clicking the “Submit” button below, I certify that I have read and agree to all the Terms and Conditions outlined above and I would like to apply to attend a Growth Clinic.

Have questions?

If you have questions about the program, please contact our team. We will be happy to answer any questions you may have.