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NAME:
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AGE:
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ADDRESS:
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What is your ethnic origin?	1. White 2. African 3. Chinese 4. Dual Heritage 5. Bangledeshi 6. Indian 7. Pakistani 8. Irish 9. Carribean 10. Other (Please Specify) 11. Prefer not to say
(If other)
What is your Age Group?	16 and under 17 - 20 21 - 25 25 - 30
Which Group do you want to join?	Derby Leicester East London
What is your current background / employment status?	Employed At College / University Unemployed Homeless / in temporary accommodation Not in Education / Training Been in / Currently in Look After Care Ex-Offender On low-income / Part Time Employment Other (Please Specify)
(If other)
Reason for joining?	Become a volunteer Gain fund-raising skills Go on to an expedition Gain media production skills Work within a group Learning new life skills Get a qualification
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Please explain why we should select you to join Camp Inclusion (Max 100 words)