Expression of Interest Form
TRIPLE A COMMUNITY CORRESPONDENTS BROADCAST PROGRAM
Student Name
*
First Name
Last Name
I am:
*
Aboriginal or Torres Strait Islander
16-17 years
18-26 years
Phone Number
*
Birth Date
*
Please select a day
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Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
Year
Gender
*
Please Select
Male
Female
Non-Binary
Prefer not to say
Guardian Name (If under 18years)
First Name
Last Name
Guardian Phone Number
Guardian E-mail
What time of the day are you available to participate in the program? (3 consecutive hours per session)
*
Please Select
Monday - Friday (9:30am-12:30pm)
Monday to Friday (1:30pm-4:30pm)
Monday to Friday (5:00pm-8:00pm)
Any Days/Times
Only Some Week Days
If you selected 'Only Some Week Days' please add your availability below including times;
Tell us a little about why you’re interested in the Community Correspondents Broadcast Program.
*
What is your post code?
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