Youth Action Committee (YAC) Application Form

2017 YAC Application Form

Applicants must be from Benalla Rural City and aged 15-25 

The personal information being collected by the Benalla Rural City Council on this form will only be used for the purpose of assessing applicants for the Youth Action Committee (YAC)

RadDatePicker
RadDatePicker
Open the calendar popup.
Please tick which of the following social media platforms you use? * (required)



Are you Aboriginal or Torres Strait Islander? * (required)

Please tick the following that apply to you: * (required)
Tick as many as applicable.








If yes, please specify what clubs and when you have been involved with them.
If you are 18 or over are you willing to obtain a Working With Childrens Check? * (required)
Please note: there is no cost involved.


(Meeting times will be negotiated with the YAC members)
Will you be able to commit to attending regular meetings of the YAC between July 2017 and June 2018? * (required)
It may be possible to participate via Skype sometimes.

Are you willing to attend training opportunities from time to time? * (required)

Please indicate below if you give permission for the Council to reproduce photgraphs/ video footage of you in our various publications or in the media? * (required)

Parent/Guardian consent if applicant is 15-17 years of age
I give permission for my son / daughter to participate in the YAC:
Please note: your parent/guardian will be contacted to confirm consent.
I give permission for photographs/video footage of my son / daughter to be used in Council promotional material including Council website and Facebook page, publications and media releases.
Please note: your parent/guardian will be contacted to confirm consent.
Endorsement - Applications must be endorsed by a teacher, support agency or non-related person over 18 who has known you for at least two years.
Please ensure that the person writing the endorsement tells us why they think this young person would be a good candidate for the Benalla Rural City Council Youth Action Committee.

 

View as a PDF(PDF, 65MB)