Regional Engagement Program (REP) Registration Form
Thank you for your interest in Multicultural NSW's Regional Engagement Program.
Please see our
Privacy Policy
for details on how Multicultural NSW handles and protects your information.
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1.
First Name
(Required.)
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2.
Last name
(Required.)
3.
Do you identify as (tick as many as apply):
A young person (18-24 years)
Aboriginal and/or Torres Strait Islander
A person living with disability
LGBTIQA+
An active community member
An active community leader
A religious or faith leader
A community based organisational representative
*
4.
Which region(s) do you live, work or study? (Tick as many as apply)
(Required.)
Greater Sydney (North and East)
Greater Sydney (West)
Greater Sydney (South)
New England and North-West
Murray Lower Darling
Hunter and Central Coast
Illawarra and South East NSW
Northern NSW
Western NSW
Riverina
Not sure (please enter your residential postcode)
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5.
Email address
(Required.)
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6.
Phone number
(Required.)
7.
Language(s) spoken, other than English
8.
Cultural heritage
9.
Religion
10.
Country of birth
*
11.
Please tell us a little about yourself that is relevant for the Regional Engagement Program. For example, any relevant work, study, or volunteering you do, or communities you are part of.
(Required.)
