Youth Futures Application Form

Please fill out one form per applicant

Training Dates:

23rd – 25th April 2018

Name –…………………………………………………………………………………………

Age –…………………………………………………………………………………………

Gender–…………………………………………………………………………………………

Address – …………………………………………………………………………………………

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Post code -…………………………………………………………………………………………

Tel No –…………………………………………………………………………………………

Email –…………………………………………………………………………………………

Ethnicity (please indicate)–

White British / White Irish / Any other White background
Mixed White and Black Caribbean / Mixed White and Black African / Mixed White and Asian
Any other Mixed background / Mixed White and Asian / Any other Mixed background
Indian / Pakistani / Bangladeshi
Any other Asian background / Caribbean / African
Any other Black background / Not stated

Each of our bedrooms accommodate up to 3-4 people (single sex). You may be required to share with other young people on the programme. If you are attending as part of a group and have a preference for who you share with please let us know the names of those you would like to share with.

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Tenure (please indicate)-

Living with parents or carers / House Association tenant
Private landlord / Council tenant
Other

Employment (please indicate)-

Full-time Student / Employed (FT or PT)
Unwaged (Not Seeking Work) / Registered Unemployed (Seeking work)

Do you have a visual impairment or need material in large print or in Braille?

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Do you have a hearing impairment that we need to be aware of?

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Do you have any mobility constraints where we could make you more comfortable?

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Do you have any other particular needs we need to be made aware of?

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Do you have any dietary requirements?

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Do require help with travel costs?

No
Yes

What is the main reason you would like to come on this training?

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Please return this completed application form to Anna Koukoulliseither by email – or by post – 32 Farringdon Street, London ECA 4HJ. If you have any queries, please call me on 0207 634 9600 or you can emailAnna Koukoullis, Community Investment & Apprentice Manager.