Members of the Chief Minister’s Round Table of Young Territorians (Round Table)
spend a 12 month term, including four meetings from February to December,
advising the Chief Minister on issues impacting Young Territorians.
Please ensure you have your Letter of Support attached to this application (Letter of
Support can be written by someone from your school, university, workplace or
community). Please note if you are successful in your application your support
person may be contacted at any time over the 12 month period.
A. PERSONAL DETAILS
Title
First Name
Surname
Date of birth
Gender
Postal address
Home address
Home telephone
Work telephone
Mobile telephone
Email address
Were you born in Australia?
Yes
No
Are you an Australian citizen or permanent resident?
Yes
No
Are you from a culturally or linguistically diverse
background?
Yes
No
Are you of Aboriginal or Torres Strait Islander descent?
Yes
No
Do you have a disability?
Yes
No
Will you be residing in the Northern Territory for the entire
2015 calendar year
Yes
No
How did you hear about the 2015 Round Table? (please
tick all that apply)
Youth NT website
Facebook
Twitter
Email from a youth
organisation
Radio
Newspaper
Television
What is the main language spoken at home?
How long have you resided in the Northern Territory?
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School
Previous Round
Table Member
Applied in
previous year
Word of
mouth
B. WHAT ARE YOU DOING NOW?
Institute/School
Year Level
Institute (University/Other Study)
Course
Stage of Course (e.g. 2nd year out of 4
year course)
Name of Employer
Role in Organisation (if applicable)
Other interests/hobbies?
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C. LETTER OF SUPPORT
Supporters Name
Position (if applicable)
Organisation (if applicable)
Address
Contact number
Email
Attach Letter of Support HERE
D. COMMUNITY INVOLVEMENT/EXTRA CURRICULAR ACTIVITIES
Please list your involvement in community activities, programs, events or organisations.
Year
Organisation/event details
Your role
Please attach any relevant supporting documents you wish to provide (optional). E.g.
certificates / media / letters of involvement.
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E. KNOWLEDGE AND INTEREST IN YOUTH ISSUES
Why do you want to join the Round Table?
What experience do you hope to gain from the Round Table?
How will you contribute to the Round Table?
What are the important issues for young people in the NT? Please describe up to
three issues that you see as important:
Please describe youth issue. Do you have any ideas for a solution to this issue?
1
Please describe youth issue. Do you have any ideas for a solution to this issue?
2
Please describe youth issue. Do you have any ideas for a solution to this issue?
3
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F. CONSULTATION WITH YOUNG PEOPLE AND THE COMMUNITY
How would you reflect the views, experiences and issues of young people in your
community to Government via the Round Table?
Who in your local community would you consult with about these issues?
G. RELEASE OF PERSONAL INFORMATION
I consent to the reasonable
disclosure by the Round Table
Coordinator of the following
information about me:
I confirm that the information I have provided in this application
is true and correct to the best of my knowledge. I
acknowledge that the Chief Minister's Round Table of Young
Territorians is an alcohol, tobacco and drugs free program and
if successful I will not consume alcohol, tobacco and other
drugs while I am involved in Round Table activities.
I confirm that the information provided in this application is true and correct to the best of my
knowledge. I give permission for the release of information outlined above.
***Young person to sign and if under 18 years must have signature from parent or
guardian also.
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