YRG Application Form
This application forma 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.




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Email *
Full Name *
Pronouns (e.g. he/him, she/her, they /them) *
Age *
Email *
Mobile Phone Number *
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. *
Required
Have you experienced anxiety, depression, or any other mental health concern, or supported someone who has? *
Which community do you live in? *
Tell us a little about yourself! What are you passionate about? What do you do with your time? *
Tell us a few reasons why you are interested in joining the YRG. *
Tell us some skills, talents or ideas you can bring to the YRG! *
Why is advocating for youth mental health important to you? *
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? *
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