Join the Winston's Wish Youth Team!
What is your age group?
12 years or under
13-25 years
Which role are you interested in?
Youth Ambassador
Youth Advisor
Both / not sure
About you - young people aged 13-25
First name
Last name
Date of birth
Please use dd/mm/yyyy format
What is your ethnic origin?
Please select...
Asian or Asian British
Black, Black British, Caribbean or African
Mixed or Multiple Ethnic Groups
White
Other Ethnic Group
Prefer not to say
Please select
Please select...
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Caribbean
African
Any other Black, Black British, or Caribbean background
White and Black Caribbean
White and Black African
White and Asian
Any other mixed or multiple ethnic background
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Roma
Any other White background
Arab
Any other ethnic group
Which gender do you identify with?
Please select...
Woman
Man
Non-binary / gender nonconforming
Prefer to self define
Prefer not to say
Please tell us
Your GP's details
(We will only contact your GP if we are concerned about you and your mental health and are unable to contact you)
About you - children aged 12 and under
Please ask a parent or guardian to fill out this application form with you. We want to know all about you, but as you are under 13, we will make contact with your parent or guardian about your application.
First name
Last name
Date of birth
Please use dd/mm/yyyy format
Ethnic origin
Please select...
Asian or Asian British
Black, Black British, Caribbean or African
Mixed or Multiple Ethnic Groups
White
Other Ethnic Group
Prefer not to say
Please select
Please select...
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Caribbean
African
Any other Black, Black British, or Caribbean background
White and Black Caribbean
White and Black African
White and Asian
Any other mixed or multiple ethnic background
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Roma
Any other White background
Arab
Any other ethnic group
Which gender do you identify with?
Please select...
Woman
Man
Non-binary / gender nonconforming
Prefer to self define
Prefer not to say
Please tell us
Your GP's details
(We will only contact your GP if we are concerned about you and your mental health and are unable to contact you)
About your parent/carer and contact details
Parent/carer's first name
Parent/carer's last name
Relationship to the child
Parent/carer's email address type
Please select...
Work
Personal
Other
Parent/carer's email address
Parent/carer's phone number type
Please select...
Mobile
Home
Work
Parent/carer's phone number
Parent/carer's postal address
Parent/carer's town/city
Parent/carer's postcode
Your contact details
Email address type
Please select...
Work
Personal
Other
Email address
Email address
Email address
Email address
Phone number type
Please select...
Mobile
Home
Work
Phone number
Mobile number
Phone number
Phone number
Postal address
Town/city
Postcode
Have you previously accessed support from Winston's Wish?
Yes
No
If you feel able, please tell us a bit about your experience of grief
Which of the following areas are you interested in getting involved with? (Please tick as many as you wish)
Creating content for other grieving young people (art, poetry, music, video, podcasts etc)
Sharing your story to inspire others
Sharing your opinions to help make services better
Meet other grieving young people
Take over our social media
Write for our website
Appear in the media
Represent us at events
Get involved with fundraising initiatives
Be involved in interviews and shortlisting for new members of staff
Get involved in delivering new projects
Help to create new resources and materials
Work alongside staff members and share skills
Other
Please tell us
Which of the following areas are you interested in getting involved with? (Please tick as many as you wish)
Sharing things that have helped you with others
Sharing your story to inspire others
Tell us what you liked about your support and what we could change to make it better
Get involved with fundraising
Work on projects with other children and young people
Help us to create new resources
Test and give feedback on our resources and activities
Share your art, writing, poetry and music with others
Share how Winston's Wish has helped you
Tell us a little about why you'd like to be part of the Winston's Wish Youth Team
Where did you hear about the Winston's Wish Youth Team?
Please select...
Facebook ad
Instagram ad
YouTube ad
TikTok
Winston's Wish website
Other website
Winston's Wish email
Other email
Word of mouth
Other
Please tell us
Do you want to stay in touch?
We would like to send you updates on the latest news, events and information about the Youth Team. Please opt in below to receive these updates. If you don't opt in, we will only contact you with information specifically relating to your application to join the Youth Team.
Yes, I would like to receive updates
No, please only contact me with information specifically relating to my application
How would you like to hear from us?
Email
Yes
No
Post
Yes
No
Phone
Yes
No
SMS text
Yes
No
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