Youth Reference Group

headsapce Mount Gambier Youth Reference Group application

Thank you for applying to be part of the headspace Mount Gambier Youth Reference Group!

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Click 'start' if you're ready to apply to be a part of something awesome!

Question Title

* 1. Contact information

Name *

Date of Birth

Address *

Address 2 *

Suburb *

Post Code *

Email Address *

Phone Number *

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* 2. if you are under 18 years of age, please provide contact details for your parent or guardian. We will need to contact them to gain consent for you to join the Youth Reference Group

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. What languages do you speak at home?

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* 4. Where were you born?

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* 5. Do you identify as Aboriginal or Torres Strait Islander?

Yes

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* 6. Have you or a family member experienced mental illness?

Yes

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* 7. Is this something you would be happy and feel comfortable to talk about?

Yes

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* 8. Please tell us a bit about yourself...

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* 9. Please describe you you are interested in joining the Youth Reference Group and what skills or ideas you would bring to the group.

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* 10. Are you involved in any other organisations?
If yes, please describe which organisations and your involvement.

Yes

Other (please specify)

Youth Reference Group

headsapce Mount Gambier Youth Reference Group application

Question Title

* 1. Contact information

Question Title

* 2. if you are under 18 years of age, please provide contact details for your parent or guardian. We will need to contact them to gain consent for you to join the Youth Reference Group

Question Title

* 3. What languages do you speak at home?

Question Title

* 4. Where were you born?

Question Title

* 5. Do you identify as Aboriginal or Torres Strait Islander?

Question Title

* 6. Have you or a family member experienced mental illness?

Question Title

* 7. Is this something you would be happy and feel comfortable to talk about?

Question Title

* 8. Please tell us a bit about yourself...

Question Title

* 9. Please describe you you are interested in joining the Youth Reference Group and what skills or ideas you would bring to the group.

Question Title

* 10. Are you involved in any other organisations? If yes, please describe which organisations and your involvement.

* 10. Are you involved in any other organisations?
If yes, please describe which organisations and your involvement.