Youth Advisory Board

Your Name *

Your Contact Number *

Email Address *

Your address *

City *

State *

Postcode *

Your Age *

16 or 17 years18-22 years23-25 years

Do you identify as being part of the LGBTQIA+ community? *

YesNo Prefer not to say

Do you identify as Aboriginal or Torres Strait Islander? *

YesNo Prefer not to say

I would describe where I live as: *

In a townOn a few acres/ hobby farmOn a farm Other

I live with: *

Both my parentsOne parentIndependently Other

If you live at home with family ( Please tick all that apply): *

My parents work full timeMy parents are not currently employedA language, other than English is spoken at home

Education and employment (Please tick all that apply) *

Transport / access (Please tick all that apply) *

I have a drivers license and access to a carI use a school bus serviceI use public transport (eg bus or train) I walk or cycle to school/work

Do you have a disability? *

Yes No Prefer not to say

If yes, what can we assist with barriers to attending.

Can you make yourself available for 5 in person meetings and additional training opportunities as required over the 12-month period. (June 2025 - May 2026) *

YesNo

If you need any support or assistance to participate in the Youth Advisory Board, please let us know how we can make sure your needs are met. ( e.g assistance with transport to attend meetings, visual impairment)

Why do you think it is important that young people in Moyne and Warrnambool have a say on issues that impact them and the community? *

Why do you think you would make a good representative for young people in your area? *

Is there anything else you would like us to know about you and why you would like to be a member of the Youth Advisory Board (YAB)? *

Our aim is to create a panel that represents the diversity of young people from the municipalities of Moyne and Warrnambool, in a safe and inclusive space. This is not a skills or experienced based panel, your qualifications, education and experiences are not part of the eligibility criteria.

PRIVACY STATEMENT

Warrnambool City Council acknowledge and respect the privacy of individuals. The information collected on this document is for the purposes of confirming and administering your participation in a youth Engagement program. It will not be disclosed to any other external party without your consent, unless required or authorised by law. If the personal information is not collected, we will not be able to contact you with more information about the program you have inquired about. By completing this form, you and/or your parents/guardians acknowledge that you are providing consent for this information to be collected.