NCS Community Experiences
Expression of Interest
Young Person's Full Name
*
First Name
Last Name
Young Person's Date of Birth
*
-
Month
-
Day
Year
Date
How would you describe your gender?
*
Male
Female
Prefer to self describe
Please describe your gender below, if not selected male or female
What is the Young Person's Ethic Background?
*
Please Select
Asian British or Asian
Black British or Black
Mixed
White
Any other Ethnic Group
Prefer not to say
What is your religion?
*
What is your sexual orientation?
*
Straight / Hetrosexual
Gay / Lesbian
Bisexual
Prefer not to say
Have you received free school meals in the last 6 years?
*
Yes
No
Do you have any physical or mental health conditions or illness lasting or expected to last 12 months or more?
*
Yes
No
If the answer to the above question is yes, do any of of your conditions or illnesses reduce your ability to carry out day to day activities?
*
Yes
No
Do you consider yourself to have a special educational need?
*
Yes
No
Do you have an Education, Health and Care Plan (EHCP)?
*
Yes
No
Are you 'Care experienced?' This includes at any point in your life
*
Yes
No
Do you regularly provide unpaid care for a relative, friend or family member with an illness, disability, mental health problem or an addiction?
*
Yes
No
Are you?
*
IN Education, Training or Employment
NOT in Education, Training or Employment
Is English your first language?
*
Yes
No
Young Person's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Young Person's Email
*
example@example.com
Young Person's Mobile Number
*
Please enter a valid phone number.
Parent/Guardian's Full Name
*
First Name
Last Name
Parent/Guardian's Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/guardian's Email
*
example@example.com
Parent/guardian's mobile number
*
Please enter a valid phone number.
How did you hear about this experience/activity?
*
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