EXCITE MediaActive Registration Form
This form will register your interest in the EXCITE programme
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First Name *
Surname *
School, College or University Name *
If you are not in education that is fine just put 'not in education'
Date of Birth *
MM
/
DD
/
YYYY
Home Telephone *
Mobile Telephone *
Email Address *
Specific Skills or areas of Interest
Please tell us which area/s of EXCITE you are interested in
A Bit About You *
Please use this box to tell us a little about yourself, your interests and aspirations. You can also put in any links to your blogs, Instagram, YouTube or Vimeo videos or any other information that showcases your work to date
Equal Opportunities Monitoring
The EXCITE programme wish to ensure that all aspects of it's work reflect diversity and support equality of opportunity. Therefore, we would like to take this opportunity to ask you to complete an equality monitoring form.  This monitoring information helps us to identify where there are gaps in our recruitment so that we can work to attract talented people from these groups and areas. It also helps us to ensure that there is no discrimination.
Gender
Clear selection
Ethnic Background
This checklist is the standard ethnic monitoring categories provided by the Commission for Racial Equality
Clear selection
Social Mobility
Do you, or have you, received free school meals at any point in the last three years?
Clear selection
Have you ever been in care? 
Clear selection
Do you consider yourself to have a disability?
The Equality Act 2010 defines disability as 'a physical or mental impairment which has a substantial long term effect on a persons ability to carry out normal day to day activities'.
Clear selection
Submit
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