Experts by Experience Application Form

Page 1: Thank you for applying to be an Expert by Experience! If you would prefer to complete your application over the phone or by email/text, please contact Amber DeRosa on aderosa@ncb.org.uk or 07802 465 985 and she will assist you with this. NCB is committed to respecting and protecting your privacy, you can find our privacy policy here - https://www.ncb.org.uk/privacystatement. Please note that we are collecting some of the below information for our own diversity monitoring and to ensure that we are hearing from a range of people as part of this project, if you would rather not disclose this information, please select 'prefer not to say'. Thank you.

1.1. Which of the groups are you applying to join? Required

I am a disabled child or young person (aged 11 to 25)

I am a care leaver (aged 16 to 25)

I am a parent (of a child aged 0-25 who who has had involvement from children’s social care)

2.2. If you are a parent, which if any of the following statements applies to you? (You can tick more than one. This question is optional and you do not have to tell us anything that you do not want to.)

One of more of my children is disabled

My family has had involvement from children’s social care

One or more of my children has been in care

3.3. Why would you like to be part of this project? (e.g. what interests you about it, what do you think you could offer or what would you like to gain from being part of it?). Please write as much or as little as you like! Required

4.4. What is your name? Required

5.5. What is your email address? Required

6.6. What is your phone number? Required

7.7. What is your address (including your postcode)?

8.8. What is your date of birth? Required

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

a.8.a. If you are aged 15 or under, please provide an email adress for a parent or carer so that we can check that it is ok that we have your personal contact details

9.9. What is your gender? Required

Female

Male

Non binary / third gender

Prefer to self describe

Prefer not to say

10.10. What is your ethnicity? Required

White British

White Other

Black British

Black Other

Asian British

Asian Other

Mixed Race (please write below)

Prefer not to say

Other

a.10.a. If you selected 'Mixed Race', please specify:

11.11. What country were you born in? Required

12.12. Do you have British Nationality?

Yes

Prefer not to say

13.13. Do you consider yourself to have a disability? Required

Yes

Prefer not to say

14.14. Do you consider yourself to be in or leaving care? Required

Yes

Prefer not to say

15.15. Do you consider yourself to be a young carer? Required

Yes

Prefer not to say

16.16. Do you consider yourself to belong to the LGBTQ community? Required

Yes

Prefer not to say