Skip to content
Netsafe Youth Action Squad Application Form
Basic Details
*
1.
Name
(Required.)
2.
Email Address
3.
Phone Number
*
4.
Age
(Required.)
15
16
17
18
*
5.
Do you represent any of our diverse communities?
(Required.)
Māori
Pacific
Ethnic Minority
Neurodiversity
*
6.
Area you live in
(Required.)
*
7.
School you attend
(Required.)
*
8.
School Support Person
Please ensure you have the support of a member of staff from your school before completing this application. Your School Support Person will be contacted if your application is successful.
(Required.)
Name of school staff member
Email address
Phone number
*
9.
Why Would you like to join the YAS?
(Required.)
