Mosaic Works – Work Experience Interest Form
This form is to be completed by young persons who are interested in doing a work experience placement through the Mosaic Works programme. Filling out this form is not a guarantee that a placement will be found, but it is the first step in registering your interest in the programme. We will aim to follow up with you within 1-2 weeks of your form submission.

 If you have any questions, contact Sierra Raposo at sierra.raposo@mosaictrust.org.uk
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First Name *
Preferred Name (if different from above)
Last Name *
Age *
Gender Pronouns *
Phone number *
Email address *
Your preferred methods of contact are: (tick all that apply) *
Required
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This form was created inside of Mosaic LGBT+ Young Persons' Trust.

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