Connexions Youth Board Membership Form

Connexions wants the Youth Board to represent the young people it works with, so we need to ask you some questions about yourself and your background to make sure we involve a wide range of people. Also, we’ll need to keep in touch with you, so we’re asking some questions about how we can contact you.

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Cnx Youth Board Membership

Name »

Your address

Your postcode

Your contact number »

Your email address (if you have one)

Your date of birth

Are you male or female?

Male
Female

Which ethnic group do you belong to?

Black - African
Black - Caribbean
Black - Other
White - British
White - Irish
White - Other
White & Black Caribbean
White & Black African
White & Asian
Mixed - Other
Indian
Bangladeshi
Pakistani
Asian - Other
Chinese
Gypsy/Roma/Traveller
Other
Prefer not to say

Where can you acces the internet? (please tick which apply)

At home
At school/college
I do not have internet access

If you access the internet elsewhere, please state where?

If you have not completed this form yourself, please say who has. What support (if any) might you need to be on the Connexions Youth Board?

How do you think you can help Connexions by being on the Youth Board? You may wish to give details about: any youth groups you belong to, your interests, future plans, issues important to you, how you may have represented the view of others on any occasion, any contact you have had with Connexions to date and more...

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