Shared Spaces Young Persons Advisory Group - Expression of Interest Form

Personal Information

NCB is organising a Young People’s Advisory Group (YPAG) to help the researchers from the University of Bristol with the Shared Spaces Project. We need young people from Belfast and Bradford to come together and share their knowledge of their city with the researchers. If you are 14/15 years old, from Belfast or Bradford, and are interested please provide some personal information below:

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* 1. Please provide your contact details

Name

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 2. Date of Birth

Date / Time

Date

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* 3. Which method do you prefer to be contacted by?

Phone

Email

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* 4. Do you have access to a computer?

Yes

No

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* 5. As you are under 16, please provide your parent's/guardian's contact information:

Parent's/Guardian's Name

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number