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Group Mentoring Application
Group Mentoring Application
Young Carer Contact Details
First Name
*
Last Name
*
We’d love to get to know you and put a face to the name so please attach a photo of yourself (and the person you care for if you have one)
*
Gender
*
Age
*
Phone
*
Date of Birth
*
Are you currently engaged in education?
*
Yes
No
If yes, what type of education?
---
Primary School
Secondary School
VCAL
TAFE
SEDA
Name of institution?
Email
*
This will be the email address used for your zoom account and where we will send you the link each week to join the video call.
Address
*
Please make sure this is your postal address as your resource pack will be sent to this address.
Parent or Guardian Contact Details
Name
*
Relationship
*
Email
*
Phone
*
Address
*
About The Caring Role
What is your relationship to the person/s you care for?(Select all that apply)
*
Brother
Sister
Father
Mother
Grandparent
Guardian
Other
Please select the reason/s why you provide care?(Select all that apply)
*
Physical disability
Intellectual disability
Mental health
Addiction
Chronic illness
Cancer
Autism Spectrum Disorder
Degenerative disorder
Genetic disorder
Acquired Brain Injury
Frailty/old age
Carer of siblings due to parent unavailability
Other
How many people do you care for?
*
---
1
2
3
4
5 or more
Tell us a bit about your role as a Young Carer.
*
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