Walking the Talk - Expression of Interest Form
Full Name
*
Pronouns
Age
*
Select
14
15
16
17
18
19
20
21
22
23
24
25
Email
*
Phone Number
Suburb/Town of Residence
*
Are you Aboriginal and/or Torres Strait Islander?
*
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both
No
Prefer not to say
Do you identify as LGBTQI+?
*
Yes
No
Prefer not to say
Do you speak any language/s other than English at home/with family?
*
Yes
No
Prefer not to say
Do you require an interpreter?
Yes
No
If you require an interpreter, what language (including AUSLAN)?
Do you have a disability and/or chronic illness?
*
Yes
No
Prefer not to say
In your opinion, what is one of the main issues with the ways organisations engage young people currently, if any?
What interests you in becoming involved in youth/healthcare advocacy?
Are you a member of any patient or community groups? If YES, what groups?
Walk the Talk!