headspace Box Hill Youth Reference Groups EOI From

headspace Box Hill are looking for young people aged 16-25 who want the opportunity to be heard and be active around youth issues. The group is excited to include and hear the voices of a diverse range of young people. As a reference group member, you will play a part in several roles, such as helping to lead and organise a project, having a voice for young people, and a say in youth issues that affect our area, among other responsibilities.

This form will take approximately 15 minutes to complete.

Personal Details

What is your First Name? *

What is your Last Name? *

Preferred name

What is your date of birth? (DD/MM/YY) *

What is the best contact number for you? *

What is your email address? *

What is you current home address?

What are your pronouns?

How do you describe your gender?

What is your Working With Children's Check (WWCC) number

If you don't currently hold a WWCC

I am under 18 years of ageI am in the process of applying and waiting for it to be processed I don't have one, but I am willing to apply for one

Emergency Contact Details

Emergency Contact Name *

Emergency Contact Number *

If we are required to contact this person, is there anything we should be aware of?

Your interest in joining the YRG - please enter as much detail as possible and really paint a picture as to who you are as a person

Please tell us a little about yourself:

Do you have any lived or living experience that you'd like to shared as part of the YRG

Please outline why you are interested in becoming a Reference Group member:

What skills/ideas could you bring to the Reference Group?

Are you involved in any other voluntary organisations? If yes, which ones and what is your involvement?

If you have a CV you'd like to upload, do so here

Browse

Any other information your like to provide?

Demographic Information - additional information

This information is not required; however, it helps us to create a demographic picture for the Whitehorse area

Do you identify as Aboriginal and/or Torres Strait Islander?

Do you identify as LGBTQIA+?

YesNoUnsurePrefer not to answer

Do you require the services of an interpreter?

YesNoUnsure

Language/Dialect required?

Do you have any communication or access needs?

YesNoMaybe

Accessibility needs required?

headspace Box Hill Youth Reference Groups EOI From

Personal Details

Emergency Contact Details

Your interest in joining the YRG - please enter as much detail as possible and really paint a picture as to who you are as a person

Demographic Information - additional information

Thank You!!