Youth Parliament 2010 Registration

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Please complete the form below to submit your application for Youth Parliament 2010 and a member of staff will process it as soon as possible. Please note that all fields marked with an askerisk (*) are mandatory.

Personal Details

First Name *

Last Name *

Date Of Birth (dd-mm-yyyy) *

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 *

About You

What is your State Electorate

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

Please specify...

What is your Experience Level?

* Remember experience is not a pre-requisite

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

If so, for how many years?

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

If yes, please give details and tell us how we can assist you

Were you born in Australia? Yes No

Country of birth

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

Language spoken

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

Carer/Elder/Support Worker Attendance? Yes No

Financial Assistance? Yes No

Other (please specify)

Why You Want To Be Involved

The following topics are the portfolios of the NSW Government. At Youth Parliament, you will be split into a team entrusted with writing a bill about this topic.

Please preference your top ten issues Press Ctrl to select more than one option

Please specify...

Please provide details of three (3) issues that you would like to discuss at YP. Please remember that these need to be State issues - for more information, see the section titled 'Issues'.

Issue #1

Issue #2

Issue #3

Why are you interesting in becoming a participant in the 2010 Youth Parliament?

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 2010 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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