Youth Advisory Council (YAC) Southport Application Form

headspace Southport Youth Advisory Council (YAC) Application Form

We are now accepting new members. Apply today!
Personal & Contact Details
Full Name*

First NameLast Name
Pronouns*
Date of Birth*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
We strongly encourage young people from diverse backgrounds to apply for YAC. The below questions are personal and optional to complete. If you are uncomfortable with answering these questions, please just leave blank.
Please tick below if you identify with one or more of the following

Aboriginal & Torres Strait IslanderLGBTIQAP+Living with a DisabilityCulturally & Linguistically Diverse
YAC is an inclusive space for everyone. As a way to advocate, members may want to share their lived experience of mental health or other life challenges. Please tick below if you identify with experiencing one or more of the following

Mental health challengesConcerns or difficulties with alcohol & other drugsCaring for someone with mental health and/or alcohol and other drug challengesChronic Health and/or a disabilityHomelessness/housing insecurityHave used a headspace service e.g. headspace Primary, Lighthouse, headspace Early Psychosis
We want to get to know you!
Tell us a bit about yourself! *
Tip! What are you interested in, a unique life experience, your biggest achievement
Why do you want to be part of headspace Southport's YAC?*
Here are some examples of projects YAC has worked on in the past. Let us know what might interest you:*

Hosting headspace promotion stalls in the communityOrganising events e.g. Youth & Mental Health Week, NAIDOC, Pride MonthSitting on interview panels to help recruit headspace staff (for members 18+ yrs old)Running fun and creative activities for young peopleMarketing & Social Media campaigns that will appeal to young audiencesPublic speaking opportunities in schools and at industry eventsGive feedback on the service to make it feel youth-friendly e.g. changing the language on forms and waiting room projectsApply to attend headspace National Conference as a youth representative
Do you have any skills, talents or passion areas that you can share with YAC?*
Tip! Tell us about any hidden talents you may have (like making epic TikTok reels) or passion areas such as LGBTIQA+ advocacy
What are you hoping to get out of being part of YAC?

Learn more about mental health and local support servicesShare my lived experience to help other young peopleBuild my professional networkMeet new people and make new friendsGet involved in planning events and activitiesLearn new skills (leadership, public speaking, team work, project planning)Add volunteer or leadership experience to my resume
YAC is a 12 month membership program and you will be required to attend 8 meetings across the year. We need you to prioritise these dates, unless you are unwell or have an urgent circumstance that prevents you from attending. Can you commit to the following 2026 meeting dates?*

Tuesday 10 February 2026Tuesday 10 March 2026Tuesday 12 May 2026Tuesday 9 June 2026Tuesday 14 July 2026Tuesday 18 August 2026Tuesday 13 October 2026Tuesday 17 November 2026
How did you hear about our Youth Advisory Council?*

Social MediaWebsiteSchool /Uni/TafeWord of mouthheadspace workerOther
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headspace Southport Youth Advisory Council (YAC) Application Form

Personal & Contact Details

We strongly encourage young people from diverse backgrounds to apply for YAC. The below questions are personal and optional to complete. If you are uncomfortable with answering these questions, please just leave blank.

We want to get to know you!