1. Mention your AREA (i.e. municipality)

2. Address and Contact Details

3. What is your gender?

4. What is your age?

5. What is your race

6. What are you currently doing?

7. What GRADE or COURSE are you doing 

8. Name of school/institution of higher learning 

9. Are you affiliated with or do you receive support from any institution?

10. If "yes" describe what the organisation does 

11. Outline the value and benefits of your affiliation and/or support

13. If "You Agree" how can "Youth Entreprenuership" help in the following

15. If "You Agree" how can "Social Justice" help in the following?