Youth Parliament 2011 Registration

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Please complete the form below to submit your application for YMCA NSW Youth Parliament 2011 - you will be notified by a member of staff once your application is received. Please note that all fields marked with an askerisk (*) are mandatory.

Personal Details

First Name *

Last Name *

Date Of Birth *

Age (as of 15th April 2011) *

Gender Male Female *

Address *

Suburb *

Post Code *

Email Address *

Confirm Your Email Address *

* Please ensure that you have regular access to this email as this will be the main means of communication

Home Phone

Mobile Phone *

School *

Year at School (in 2011) *

About You

What is your State Electorate Find your state electorate

How did you find out about the NSW Youth Parliament program?

What is your Experience Level?

Parliamentary Knowledge Beginner Intermediate Experienced

Debating Beginner Intermediate Experienced

Speech Writing Beginner Intermediate Experienced

Have you been a participant in Youth Parliament before? Yes No

Additional Information

The following questions are voluntary. It is your choice if you would like to share this information with us. We would like to provide any special services you might need and make the experience as relevant and enjoyable for you as we can.

Do you identify as having a disability? Yes No

Were you born in Australia? Yes No

Do you speak a language other than English at home? Yes No

Do you identify as Aboriginal? Yes No

Do you identify as Torres Strait Islander? Yes No

Have you ever been - or are you now - under the care of the State or Guardianship of the Minister? Yes No

Wheelchair Access? Yes No

Interpreter Services? Yes No

Do you require a carer, elder or support worker in attendance? Yes No

Why You Want To Be Involved

If selected to attend the YMCA NSW Youth Parliament, you will be appointed to a committee to investigate a certain issue and then write a Bill to solve it. Please select your top ten issues out of those listed below in order of preference.*

Preference #1

Preference #2

Preference #3

Preference #4

Preference #5

Preference #6

Preference #7

Preference #8

Preference #9

Preference #10

For your top three portfolios, as preferenced above, please pick a certain issue within that portfolio and explain what you are passionate about it? What solutions do you have for each issue? Please be careful to identify the portfolio, issue and solution.

Issue #1

Issue #2

Issue #3

Why are you interested in becoming a participant in the YMCA NSW Youth Parliament 2011?

What makes you a good candidate to represent your electorate?

Acceptance

By submitting this form you are stating that you wish to participate in the 2011 Youth Parliament and that you have read the conditions of entry and are prepared to meet these conditions if selected.

I agree to the above statement. *

Terms and Conditions

Please review the Terms and Conditions on the main Youth Parliament page.

YMCA Sydney

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