Youth membership

Aged 16 to 25 ?

Have experience of homelessness ?

Live in England ?

Want to make a difference and influence how young people’s services are developed and delivered to you ?

Want to meet new young people, and develop your skills and confidence ?

We are always looking for new Members to join our team. Training and expenses provided.

If you are interested in becoming a Member of the National Youth Reference Group, complete the form below and submit it to us, or alternatively email us at nyrg@stbasils.org.uk

Expression of Interest

Please fill in the form below to request membership of the National Youth Reference Group

Name of young person:

Date of birth: Day Month Year

Gender:

Are you:

Young person’s contact number:

Your email

Next of kin name:

Relationship:

Contact telephone of next of kin:

Do you identify yourself as disabled?

If ‘Yes’, please specify the nature of your disability

Support workers name:

Job Title:

Organisation name & address:

Support workers contact number:

Email:

Equal opportunities monitoring

We would be grateful if you would complete the following details about yourself. This information is entirely confidential and is only presented as statistics to Birmingham City Council and The Department for Communities and Local Government. By completing this section, you will help us monitor NYRG Membership.

Would you describe your ethnic origin as: (please tick the appropriate box)


Black or Black British – Any Other (please specify)


Mixed – White and Any Other (please specify)


Any other Ethnic Group

How would you define your sexuality

How would you define your religion

Do you live in

How did you hear about NYRG?