1.

Your given name?

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* 1. Your given name?

Your surname?

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* 2. Your surname?

How would you like your name to appear on official Youth Parliament documents?

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* 3. How would you like your name to appear on official Youth Parliament documents?

Your date of birth?

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* 4. Your date of birth?

Date / Time
How old will you be on the 8th of July 2018?

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* 5. How old will you be on the 8th of July 2018?

Your gender?

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* 6. Your gender?

Your primary phone contact?

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* 7. Your primary phone contact?

Is this your personal number?

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* 8. Is this your personal number?

A secondary phone contact?

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* 9. A secondary phone contact?

Is this your personal number?

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* 10. Is this your personal number?

Your email address?

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* 11. Your email address?

Please confirm your email address.

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* 12. Please confirm your email address.

Your postal address?

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* 13. Your postal address?

Your suburb/town/city?

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* 14. Your suburb/town/city?

Your postcode?

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* 15. Your postcode?

Do you currently...

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* 16. Do you currently...

If you are studying, what is the name of your institution, and what course are you studying?

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* 17. If you are studying, what is the name of your institution, and what course are you studying?

Are there any factors that may impact on our capacity to support your participation in Youth Parliament

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* 18. Are there any factors that may impact on our capacity to support your participation in Youth Parliament

Do you live, or is your permanent home in, a regional, rural or remote area of Western Australia?

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* 19. Do you live, or is your permanent home in, a regional, rural or remote area of Western Australia?

Do you identify as being of Aboriginal or Torres Strait Islander origin?

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* 20. Do you identify as being of Aboriginal or Torres Strait Islander origin?

What language do you speak at home?

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* 21. What language do you speak at home?

What is your country of birth?

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* 22. What is your country of birth?

Do you identify as having a disability?

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* 23. Do you identify as having a disability?

What type of high school do you/did you attend?

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* 24. What type of high school do you/did you attend?

What significant issue facing youth today are you most passionate about and why? (200 word limit)

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* 31. What significant issue facing youth today are you most passionate about and why? (200 word limit)

Why do you think you should be selected to participate in Youth Parliament 2018? (200 word limit)

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* 32. Why do you think you should be selected to participate in Youth Parliament 2018? (200 word limit)

What do you want to achieve through your participation in Youth Parliament 2018? (200 word limit)

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* 33. What do you want to achieve through your participation in Youth Parliament 2018? (200 word limit)

Have you participated in Youth Parliament before?

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* 34. Have you participated in Youth Parliament before?

Are you currently a member of a Political party?

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* 35. Are you currently a member of a Political party?

Where did you hear about Youth Parliament?

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* 36. Where did you hear about Youth Parliament?

Have you read and understood the Application Pack?

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* 38. Have you read and understood the Application Pack?

Are you able to, if accepted, to commit to attending all Youth Parliament events including Training Day (April 7th) and the Residential Camp (July 8th-13th)?

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* 39. Are you able to, if accepted, to commit to attending all Youth Parliament events including Training Day (April 7th) and the Residential Camp (July 8th-13th)?

Do you accept the Terms and Conditions of the Western Australian YMCA Youth Parliament program, as published on our website?

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* 40. Do you accept the Terms and Conditions of the Western Australian YMCA Youth Parliament program, as published on our website?

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