Name
Address
Postcode
Date of Birth / Age
E-Mail
Landline / Mobile
Name of youth group, club or organisation (if you belong to one):

Why do you want to be involved in Award Panel?

Alternatively this question may be answered in a video format or with an A4 picture with a brief explanation or commentary provided in the space below, e.g. by an adult or support person. Please contact us for more guidance on alternative formats.

For example:
Tell us if you are involved in a youth group, or club and what you do there?
You might want to tell us briefly about any qualities and skills you have that you can bring to the panel, such as listening skills, having good ideas, taking responsibility and getting on well with others?
In a sentence or two, tell us what you hope to get from being a panel member like learning new things, meeting new people, building confidence and supporting others.

Please use the space below to let us know about any additional support you may require including mobility, access, communication or any special dietary requirements you might have.

Consent

I consent to the Youth Council for NI (YCNI) storing personal data / information provided by me and I understand that it will only be used by YCNI or those with a legitimate interest in the small grants programme and will not be passed on to any other agency or individual.
Signature of child or young person / Date
Parent / Guardian's Signature -If U-18 only / Date

If you are completing this form onscreen and can’t then sign it,

or you are using an alternative format to provide the information,

please type your name (and your parent or guardian’s name if you are U-18)

in the signature box, date it and email it to

Completed forms can be printed out, signed and returned…

By post to / or by email / or by text
Joe Hawkins
Programme Manager
YCNI
Forestview, Purdy’s Lane
Belfast, BT8 7AR / It can be scanned
and emailed to
/ Take a clear and readable photo of both sides
of the form and
forward it by text to
07850 880 959

Also, if you agree to take part in the Award Panelyou will need to complete and return other short forms, e.g. one is an emergency contact details form, another is a confidential equality monitoring form, and a third is a photo consent form.

We will forward these to you in time for the Taster Day.

If you have any questions please call the Programme Manager on
028 9069 0423 (Mon-Fri 9am-5pm) / Or text your name and the words
Small Grants to 07850 880 959
and we’ll call you
Or email your question to

The closing date for returning an application form is Friday 13th November 2015