Youth Advisory Group Registration Form
PERSONAL DETAILS (Please complete in BLOCK CAPITALS, as fully as possible)
Surname/Family Name:Forename:
Preferred Name (known as):
Address:
E-mail Address:
Telephone:
Home:
Mobile:
Can you give an example of when you have had to demonstrate your communications skills?
What would you bring to the group and what would you hope to learn from your experience?
Please tell us why you would like to be part of the Advisory group?
It would be helpful to understand if you attend school, college are employed/unemployed or other.
Please select from drop down list.
SchoolCollegeEmployedUnemployedOther (please double click on the tile)
If other, please specify:
DECLARATION
For you to sign:I certify the information on this form is accurate.
Signed: Date:
Parental Consent:
I agree to my son/daughter taking part in all the activities associated with the Youth Advisory Group.
Signed: Date:
Please return your completed registration form and the below monitoring form to
or print a copy and return to:
Engagement Team
Office of the Police and Crime Commissioner
Ploughland House
62 George Street
Wakefield
West Yorkshire
WF1 1DL
EQUAL OPPORTUNITIES MONITORING FORM
The Office of the Police & Crime Commissioner is an Equal Opportunities Employer.
This information will be treated in the strictest confidence and will only be used for monitoring purpose.
Date of Birth:What is your gender?
Male
Female / What is your religion or belief?
None
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Any other religion/belief
(please state)
Prefer not to say
What is your ethnicity?
White – British
White – Irish
White – Any other white background
Mixed – White and Black Caribbean
Mixed – White and Black African
Mixed – White and Asian
Mixed – Any other mixed background
Asian or Asian British – Indian
Asian or Asian British – Pakistani
Asian or Asian British – Bangladeshi
Asian or Asian British – Any other Asianbackground
Black or Black British – Caribbean
Black or Black British – African
Black or Black British – Any other black background
Chinese
Any other background
Do you consider yourself to have a
disability?
Yes
No
If you have indicated that you have a disability, is your disability a:
Sensory disability
Mobility disability
Mental ill health
Learning disability
Other (Please state)
Prefer not to say / How do you identify your sexual
orientation?
Gay/Lesbian
Bisexual
Heterosexual
Prefer not to say