Fill out the questions below!

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* 1. Please provide your contact details.

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* 2. What is your date of birth?

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* 3. Where were you born and what language/s do you speak at home?

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* 4. Please tell us a bit about yourself.

(For example: I am 15 years old and attend alternative education centre 3 days a week, I like skate-boarding etc)

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* 5. Please let us know, why you are interested in becoming a Youth Reference Group member?

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* 6. What skills and ideas could you bring to the Youth Reference Group?

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* 7. What are you passionate about contributing to headspace Redcliffe?

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* 8. Are you happy to attend fortnightly meetings and help out at community events if successful in your role as a YRG member?

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