Youth Mental Health Advisory Group - Nomination

Tell us why you are interested in joining the youth steering group.

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* 1. About you

Full Name

Preferred name

Pronouns

Age

Gender

Address

Contact number

Email address

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* 2. Do you identify as any of the following?
* You don’t have to answer this question, however we are collecting it to help us choose a diverse team.

Current or previous experience of mental health challenges

Aboriginal or Torres Strait Islander

Person of colour

From a refugee or migrant background

Living with a disability and/or chronic illness

LGBTIQA+

Being a young parent or person who has caring responsibilities

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* 3. Do you live, work, study, volunteer, or visit organisations in the City of Kwinana?

Yes

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* 4. Do you have any dietary requirements? (If yes, please tell us what they are)

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* 5. Do you have any accessibility requirements? If yes, please tell us about them.
*This can include things like needing interpreters, documents in larger/different print, accommodations for sensory needs)

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* 6. If you are under 18*, please also complete the section below

Parent/guardian contact number

Parent/guardian email

My parent/guardian agrees that i can become a peer researcher

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* 7. * If you are an independent minor or have another reason that you cannot get parental consent. This
doesn’t mean you cannot be considered for a place. We may just need to have a chat about how we can
help you participate. If this applies to you, just tell us below and we will be in contact.

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* 8. Tell us why you are interested in joining the youth steering group.
Suggestion: You may like to tell us a bit about your experience(s) with mental health challenges and/or
mental health systems (such as services, healthcare support etc.)

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* 9. A group works best when people bring different skills, talents, and interests. Tell us a bit
about what skills you think you could bring to the group.
Suggestion: You may like to tell us what you think you are good at or like doing, for example some people
are great planners, some people are creative, some have excellent design skills and others are good
listeners.

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* 10. This project will involve a number of discussions about mental health topics. This may
sometimes be difficult, and we want to support members of the group well. Can you tell us bit
about what support systems you have in place that you might be able to use during the
project if needed.
Suggestion: This could be family, friends, community, elders, or organisations that you are connected with.

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* 11. Referee
Please provide the details of one person that we can contact to talk with about your suitability for the role.
For example, a teacher, a coach an employer—we can also accept a family member.

Name

Relationship to you

Contact number

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* 12. Agreement
I agree that if I am selected to be part of the Youth Steering Group, I will:

Attend regular meetings to the best of my capacity

Actively participate and contribute to the co-design of projects

Remain in contact with the group coordinator by phone, email, or other method

Apply for a Working with Children Check (if over 18) – we will help with this

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* 1. About you

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* 2. Do you identify as any of the following?* You don’t have to answer this question, however we are collecting it to help us choose a diverse team.

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* 3. Do you live, work, study, volunteer, or visit organisations in the City of Kwinana?

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* 4. Do you have any dietary requirements? (If yes, please tell us what they are)

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* 5. Do you have any accessibility requirements? If yes, please tell us about them.*This can include things like needing interpreters, documents in larger/different print, accommodations for sensory needs)

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* 6. If you are under 18*, please also complete the section below

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* 7. * If you are an independent minor or have another reason that you cannot get parental consent. Thisdoesn’t mean you cannot be considered for a place. We may just need to have a chat about how we canhelp you participate. If this applies to you, just tell us below and we will be in contact.

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* 8. Tell us why you are interested in joining the youth steering group.Suggestion: You may like to tell us a bit about your experience(s) with mental health challenges and/ormental health systems (such as services, healthcare support etc.)

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* 11. RefereePlease provide the details of one person that we can contact to talk with about your suitability for the role.For example, a teacher, a coach an employer—we can also accept a family member.

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* 12. AgreementI agree that if I am selected to be part of the Youth Steering Group, I will:

* 2. Do you identify as any of the following?
* You don’t have to answer this question, however we are collecting it to help us choose a diverse team.

* 5. Do you have any accessibility requirements? If yes, please tell us about them.
*This can include things like needing interpreters, documents in larger/different print, accommodations for sensory needs)

* 7. * If you are an independent minor or have another reason that you cannot get parental consent. This
doesn’t mean you cannot be considered for a place. We may just need to have a chat about how we can
help you participate. If this applies to you, just tell us below and we will be in contact.

* 8. Tell us why you are interested in joining the youth steering group.
Suggestion: You may like to tell us a bit about your experience(s) with mental health challenges and/or
mental health systems (such as services, healthcare support etc.)

* 11. Referee
Please provide the details of one person that we can contact to talk with about your suitability for the role.
For example, a teacher, a coach an employer—we can also accept a family member.

* 12. Agreement
I agree that if I am selected to be part of the Youth Steering Group, I will: