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bibic
Transforming lives through developmental therapy
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Youth Ambassador application form
bibic Youth Ambassador application form
Step
1
of
5
20%
Name
First
Last
Address
House name/number
Address Line 2
City
County
Postal Code
Email
Contact number
Why do you care about our mission? (200 words)
What would you like to gain from this experience? (50-100) words
What programmes or youth related activities have you previously been involved in?
What programmes or youth related activities have you previously been involved in?
What social action have you done yourself?
Examples might include volunteering, fundraising, community organising, campaigning, mentoring, befriending or caring. These might be opportunities you have taken up through an organisation or your school/ college/university or that you have arranged yourself.
Are you able to travel independently to attend the AGM?
Yes
No
If No, what support would you need to be able to attend?
Education
Work Experience
Declaration
Consent
I agree to the below
If you knowingly give any false information, or withhold any information, if you have been appointed, this may lead to your appointment being withdrawn or to dismissal.
If you are made an offer, bibic reserves the right to confirm the basis of any information brought to its notice, relevant to this application. This will include approaching any former employers, whether proposed as referees.
All information will be kept in accordance with the requirements of the Data Protection Act 1984.
• I declare that to the best of my belief; the above information is correct.
• I agree to complete a Disclosure and Barring Service (DBS) check.
• I agree that any offer of volunteering will be subject to satisfactory references.
Signature
Date
MM slash DD slash YYYY
References
References (Please list two references for us to contact regarding your suitability for this role)
Reference one name
First
Last
Address
House name/number
Address Line 2
City
County
Postal Code
Email
Capacity in which known to you (i.e. Line Manager, Teacher, Family friend)
Reference two name
First
Last
Address
House name/number
Address Line 2
City
County
Postal Code
Email
Capacity in which known to you (i.e. Line Manager, Teacher, Family friend)
Many thanks for your interest in bibic
Please send this application to Pip Buckley – CEO – philippa.buckley@bibic.org.uk or via post to bibic, Old Kelways, Somerton Road, Langport, Somerset, TA10 9SJ
