Nomination form

Required fields are marked with an asterisk (*).

1. Eligibility

   1. Eligibility *

      • I am aged 12-25 years
      • I am a Queensland resident
2. Your details

   1. Name *
   2. Email *
   3. Phone *
   4. Residential address

      1. Address line 1 *
      2. Address line 2
      3. 1. Suburb/town *
         2. State *
         3. Postcode *
   5. Year of birth *
3. Personal details

   1. Gender *

      • Female
      • Male
      • Self-described (please specify)
      • Prefer not to say
   2. Self-described gender
   3. Do you identify as

      • Aboriginal and Torres Strait Islander young person
      • LGBTIQ+ young person
      • Young person with disability
      • Young person from a regional or remote area
      • Young carer
      • Young person from a culturally and linguistically diverse background
   4. Do you have lived experience of

      • Homelessness
      • Youth justice
      • Out-of-home care
4. Statement

   1. Please attach a brief statement (maximum one page) explaining a little bit about yourself, your knowledge and understanding of key issues facing young people, and what strong networks you have with whom you can connect. * PDF, Document, RTF or text only, maximum file size 5MB.
5. Parent/guardian consent

   1. Are you under 18 years of age? *

      • Yes
      • No
   2. Parent/guardian's name
   3. Parent/guardian's email
   4. Parent/guardian's phone
   5. Relationship to nominee
6. Declaration

   1. I consent to provide the above information in respect to myself and understand that there is no legal obligation for me to do so.
      I declare that the personal information provided by me in this form is complete and correct to the best of my knowledge.
      I understand that I may be asked to consent to a criminal history check being undertaken in respect of myself and that the results of that check may be taken into account by the Queensland Government in assessing my suitability for appointment.
      I will endeavour to attend all scheduled Youth Strategy Engagement Group meetings.
      I will perform my role consistent with the Public Service Code of Conduct.
      *

      • I verify, confirm and declare the above

Privacy statement

The Department of Environment and Science collects personal information from you, including information about your:

• name
• email address
• address
• telephone number
• year of birth
• diversity
• lived experience.

We collect this information to assess suitability for membership on the Youth Strategy Engagement Group.

We will only use your information for this purpose. It will otherwise not be used or disclosed unless authorised or required by law. Your personal information will be handled in accordance with the Information Privacy Act 2009.