Complete this form to register your interest in the next Youth Mentor Program.Please send any questions to terrycampesefoundation@outlook.com Young person's details Name * First Name Last Name Date of birth * MM DD YYYY Phone number Email * Select your local program group Select Braidwood Canberra Goulburn Queanbeyan Crookwell What school do you go to? * Gender * Select Male Female Other Do you identity as Aboriginal or Torres Strait Islander? * Select Yes No How did you find out about this program? * Why would you like to be a part of this program? * Write one goal you would like to achieve by the end of the program * Are you ready to commit to this program? * To get the most out of this program you will need to attend: • Weekly mentoring and training sessions (about 2 hours each). • Fundraising and community events as planned by the mentors. • Weekend bush walks and catch ups with all program groups (about one a month). • The final trip away with the group to Tonga. (4-15 July 2025) Yes, I commit to participating in as much of the program as I can. Please provide details about any current or future ongoing commitments you will have during the program. For example: sports, music lessons, etc. This will not exclude you from participating, it will help us to schedule program activities. Parent/guardian details: Name * First Name Last Name Phone number * Email Are you able to drop/pick up your young person for all program activities? * Select Yes Most of the time Sometimes No Thank you for expressing interest in the TCF Youth Mentor Program.We’ll take a look at your submission and get back to you as soon as we can.If you have any questions, please email info@terrycampesefoundation.com.auThanks,Terry Campese
