headspace Ashfield Youth Reference Group (YRG) Application
Street Address Line 2
State / Province
Postal / Zip Code
Date of birth
Gender assigned at birth
Current gender identity
What languages do you speak at home?
Where were you born?
Are you Aboriginal or Torres Strait Islander?
Are you from a rural or remote area?
Do you have a family member with a mental illness?
Do you identify as having/had a mental illness?
Is this something that you would be happy (and feel comfortable) talking about?
Please tell us a bit about yourself?
(For example: I am 15 years old, and attend alternative education centre 3 days a week, I like skate-boarding etc)
Please describe why you are interested in becoming a Youth Reference Group member?
What skills and ideas could you bring to the Youth Reference Group?
Are you involved in any other organisations? If yes, which ones and what is your involvement?
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