Join the MND National Youth Hub

Application form - MND National Youth Hub

About the MND National Youth Hub

The MND National Youth Hub is a program operated by Motor Neurone Disease New South Wales (MND NSW) with involvement from other state MND associations across the country. The program is open to young people between the ages of 5 and 24 years who have a family member or friend who is living with Motor Neurone Disease (MND).

The MND National Youth Hub provides information and education about MND and provides opportunities for young people to connect with others from across the country who are sharing similar experiences. The program may offer free educational products, a support group and from time-to-time the program may offer competitions with prizes.

It should take you about 5 minutes to complete this Application Form. Where the applicant is aged 17 years and under, there is a section that must be completed by the parent or guardian.

How we use the information you provide

The information collected below will be used to ensure we link you to the right support people and programs within our organisation.

All information provided will be held by MND NSW and used by us to provide support, information and to assist us communicate with you. We take your privacy extremely seriously and will work within all legislation and our own policies and procedures to keep your information safe. We will only share information with those people you have authorised. You can, at any time withdraw or change any of the information provided, including making changes or updates to authorised persons, by contacting us ph. 1800 777 175 or 02 8877 0999. You can view our privacy policy at www.mndnsw.org.au or ask for a copy to be posted to you.

You will always be the first point of contact for decision making. Those authorised to speak on your behalf will only be contacted if you have asked us to do so or if you are unable to speak/communicate on your own behalf for any reason.

What happens after you submit your Form?

After we receive your form, we will contact you within 2 working days.

To proceed please click the Next button below.

Questions marked * require an answer

This section is about the person wanting to join the MND National Youth Hub

Youth First Name

Youth Last Name

Youth Date of Birth (dd/mm/yyyy)

Street

Suburb/Town

State/Territory

Postcode

Email

Do you identify as Aboriginal or Torres Strait Islander?

No

Yes, Aboriginal

Yes, Torres Strait Islander

Yes, both Aboriginal and Torres Strait Islander

Prefer not to say

Please indicate the family member or friend who is living with MND (For example, father/mother/grandfather/friend)

Is this family member or friend a member of an MND state association?

No

Yes

Is this person aware of this application?

No

Yes

This section is for the Parent/Guardian to complete if the person wanting to join the MND Youth Hub is aged 17 and under.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Relationship to the child

Parent/Guardian Street

Parent/Guardian Suburb/Town

Parent/Guardian State/Territory

Parent/Guardian Postcode

Parent/Guardian Phone (Home)

Parent/Guardian Phone (Mobile)

Parent/Guardian Email

All Applicants to complete. These are the details of the person MND NSW should contact on the applicant’s behalf in the event of an emergency.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Thank you for your interest in joining the MND National Youth Hub.

We will contact you within 2 working days. If you need to contact us before we contact you, please phone MND NSW 02 8877 0999 or email nationalyouthhub@mndnsw.org.au

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Application form - MND National Youth Hub

To proceed please click the Next button below.

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