Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
YRG Application Form
This application form is for young people ages 16-25 years old who are interested in joining the Youth Reference Group for headspace Goulburn or headspace Yass.
Please make sure you read the information document below before applying.
headspace Goulburn & headspace Yass youth reference group
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Pronouns (e.g. he/him, she/her, they /them)
*
Your answer
Age
*
Your answer
Email
*
Your answer
Mobile Phone Number
*
Your answer
Please share if you identify with any of the options below. These are groups we would like to make sure have representation in our YRG.
*
Aboriginal and/or Torres Strait Islander
LGBTIQ+
Young Man
Have had a difficult relationship with alcohol or drugs
Have experienced unstable housing or couch surfing
None of the above
Other:
Required
Have you experienced anxiety, depression, or any other mental health concern, or supported someone who has?
*
Option 1
Which community do you live in?
*
Goulburn Mulwarre
Yass
Other:
Tell us a little about yourself! What are you passionate about? What do you do with your time?
*
Your answer
Tell us a few reasons why you are interested in joining the YRG.
*
Your answer
Tell us some skills, talents or ideas you can bring to the YRG!
*
Your answer
Why is advocating for youth mental health important to you?
*
Your answer
Tell us how you will balance being part of the YRG with other commitments in your life (study, work, sport, hobbies etc.) with being in the YRG?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
