Skip to content
Biomedical Research Centre Young Person's Advisory Group Application
*
1.
Name
(Required.)
*
2.
Date of birth (NOTE You must be aged between 14 and 18 to join the group)
(Required.)
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
3.
email address
(Required.)
4.
Telephone number
*
5.
Parent/carer name
(Required.)
6.
Parent/carer email, telephone number or postal address (we will need this so that we can contact them for consent to work with you)
Address
Address 2
London Borough
Post Code
Email Address
Phone Number
*
7.
School name and address (we need this to ensure that you are eligible to join the group. We can only accept applications from students from schools in Lambeth, Southwark or Lewisham)
(Required.)
School name
Address
*
Address 2
London Borough
Post Code
*
*
8.
Why do you want to join the group? 150 words
(Required.)
*
9.
What do you think you can bring to the group? (What skills and experience do you have? Have you taken part in research? What are you doing or have done at school that could help this group?) 150 words
(Required.)