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Full name

Date of birth *

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School

TAFE

Suburb of residence

Email address *

Phone number

Preferred method of contact

• Phone
• Email

Your preferred pronoun For example: she / her | him / he | other

Do you identify as Aboriginal or Torres Strait Islander?

• Yes
• No

What cultural heritages do you embrace?

Are you currently studying?

• Yes
• No

Are you currently working?

• Yes
• No

Do you identify as a person living with disability?

• Yes
• No

What do you see as the top issues impacting young people in Eurobodalla?

What is your motivation for applying to join Youth Committee?

What do you believe you would contribute to the Youth Committee?

Are you available to attend monthly meetings on Thursday's 10am-12pm during school terms?

• Yes
• No

Consent

Do you give permission for Council to use photos and images of you to promote youth events and activities? *

• Yes
• No

I have read and understand the Youth Committee guidelines and meeting procedures *

• Yes

If you are under 18 years old, your parent / guardian must support your application. Do you consent for Council to contact your parent / guardian to seek consent to participate?

• Yes
• No

Parent / guardian's name

Relationship to applicant

• Mother
• Father
• Legal guardian
• Other

Parent / guardian phone number