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* 1. Full name

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* 2. Full address

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* 3. Postcode

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* 4. Which school (or other main learning institution) did you attend between the age of 11 and 16?

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* 5. What is the highest qualification you have?

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* 6. Are you currently in education?

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* 7. If you are currently in education, tell us what you are doing.
(If you are not currently in education, skip to the next question.)

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* 8. Are you currently in employment? This can include paid or unpaid employment, including apprenticeships, internships, or paid jobs of any sort.

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* 9. If you are currently in employment, what sort of employment is it? 
(If you are not currently in employment, skip to question 11.)

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* 10. If you are in employment, please tell us the name of your employing organisation, and your role there.
(If you are not currently in employment, skip to question 11.)

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* 11. Are you doing any vocational training, where you are learning a trade or preparing to become a technician?

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* 12. What extra-curricular activities do you do?

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* 13. What do you hope to gain from the programme? Rank the choices below in your order of priority.

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* 14. Questions 15 to 22 list a set of skills. Think about how good you are at each of these, and score yourself.

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* 15. Skill 1:  Confidence to deal with challenging situations with friends, peers and family

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* 16. Skill 2: Confidence to deal with challenging situations with wider society

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* 17. Skill 3:  Confidence to make good decisions

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* 18. Skill 4:  Being an active citizen and helping to solve social or community problems

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* 19. Skill 5:  Mentoring other young people

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* 20. Skill 6: Sharing my skills with friends and peers

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* 21. Skill 7: Writing good CVs/ job applications

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* 22. Skill 8: Approaching potential employers regarding opportunities I am interested in

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* 23. Does your parent or primary carer speak English?

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