APPLY FOR THE PROGRAM

We will be accepting applications for the 2012 Kokoda Challenge Youth Program soon.

Applications will close in March and all applicants will be interviewed from April 2012.

The new intake of Kokoda Kids will be announced in May 2012.

Kokoda Challenge Youth program branches can be found in Brisbane, Logan, the Gold Coast, Tweed & Melbourne.

Please either fill out the application form below or click here to download an application form and email it to dan@kokodachallenge.com

  Required fields are marked with red dots.

About You

First Name
Last Name
Address
Suburb / Town
State		-- State -- ACT NSW NT QLD SA TAS VIC WA
Postcode
Date of Birth		01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913
Email
Home Phone
Mobile
What KCYP branch do you want to join?		Brisbane Gold Coast Tweed Heads Melbourne
Are you currently studying?		No     Yes
School/Institution
Level/Course
Please tell us about yourself
What do you know about the Kokoda Challenge Youth Program (KCYP)?
What do you hope to achieve by participating in the Kokoda Challenge Youth Program?
How do you think the Kokoda Challenge Youth Program might influence your future?
Who do you feel will support your involvement in the program? (please specify family members, friends, youth worker etc)
Can you please tell us about your known or anticipated time commitments in 2010 (work, family, etc)
How would you rate your level of fitness?		Very Unfit       Somewhat Fit       Fit       Very Fit
Do you have any known medical conditions?
Have you had any past injuries/operations?
Parent / Guardian Details
First Name
Last Name
Email
Home Phone
Mobile
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