Young People's Reference Panel

TMAG Young People's Reference Panel

2022 Application Form
Applications close 5:00pm, Friday 3 February 2023
Dates for commitments for members of the Young People’s Reference Panel in 2023:

Meeting 1: 4:00 pm – 5:30 pm, Thursday 23 February 2023

TMAG behind-the-scenes excursion: 10:00 am – 3:00 pm Thursday 13 April 2023

Meeting 2: 4:00 pm – 5:30 pm, Thursday 8 June 2023

Meeting 3: 4:00 pm – 5:30 pm, Thursday 14 September 2023

Lift Off! Festival for Children and Young People: 4 – 7 October 2023

Meeting 4: 4:00 pm – 5:30 pm, Thursday 16 November 2023
Application Form 2023
Why do you wish to become a member of the TMAG Young People's Reference Panel?*
What interests you most about the Tasmanian Museum and Art Gallery?*
What strengths and skills do you feel you will contribute to the TMAG Young People's Reference Panel?*
Choose one thing you are interested in and tell us about it. It can be anything at all.*
Applicant Details
Name*

First Name Last Name
Date of Birth

DayMonth Year
Date
Gender
Female, Male, Other
School Name
What grade/year will you be at school in 2023?
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number (Applicant)
Please enter a valid phone number.
Email (Applicant)
example@example.com
Name (Parent/Guardian)*

First Name Last Name
Phone Number (Parent/Guardian)*
Please enter a valid phone number.
Email (Parent/Guardian)*
example@example.com
Are you from an Aboriginal or Torres Strait Islander?*

YesNo
Are you from a non-English speaking background?*

YesNo
If yes, which language/s do you speak? And/or which culture/s do you identify with?
Do you have a disability?*

YesNo
If yes, please provide details of specific needs.
Do you have any dietary requirements?*

YesNo
If yes, please provide details of your requirements.
Referees

In the space below, please provide the names of two people who can tell us more about you, for example a teacher, sports coach, employer or relative.
Referee 1 Name

First Name Last Name
Referee 1 relationship to you
Referee 1 Email
example@example.com
Referee 1 Phone Number
Please enter a valid phone number.
Referee 2 Name

First Name Last Name
Referee 2 Relationship to you
Referee 2 Email
example@example.com
Referee 2 Phone Number
Please enter a valid phone number.
Declaration of Applicant
Personal Information Protection Statement

Personal information is collected from you for the purpose of convening and running the Young People’s Reference Panel and obtaining consent to publish photographs or video images. It will be held by the Tasmanian Museum and Art Gallery, Department of State Growth. Personal information is managed in accordance with the Personal Information Protection Act 2004. You may access your personal information by application to the business unit named above.
I your nameof forward my application for membership of the TMAG Young People's Reference Panel.
Signature (Applicant)*

Clear
I your name, the parent/legal guardian of the minor named above ("Applicant"), give permission for the Applicant to participate in the TMAG Young People's Reference Panel if selected.
Signature (Parent/Guardian)*

Clear
Please verify that you are human*
Thank you for your interest in TMAG’s Young People's Reference Panel. We will be in touch in February. If you have any queries please contact TMAG.Bookings@tmag.tas.gov.au
Should be Empty:

TMAG Young People's Reference Panel

Applications close 5:00pm, Friday 3 February 2023

Referees

Declaration of Applicant