1. First Name:*

2. Last Name: *

3. Date of Birth:*

(You should be 29 years or younger at the time of the application submission)

4. Gender:*

5. Country of Residence:
---Antigua and BarbudaAustraliaThe BahamasBangladeshBarbadosBelizeBotswanaBrunei DarussalamCameroonCanadaCyprusDominicaEswatiniFijiThe GambiaGhanaGrenadaGuyanaIndiaJamaicaKenyaKiribatiLesothoMalawiMalaysiaThe MaldivesMaltaMauritiusMozambiqueNamibiaNauruNew ZealandNigeriaPakistanPapua New GuineaRwandaSaint LuciaSamoaSeychellesSierra LeoneSingaporeSolomon IslandsSouth AfricaSri LankaSt. Kitts and NevisSt. Vincent and the GrenadinesTongaTrinidad and TobagoTuvaluUgandaUnited KingdomUnited Republic of TanzaniaVanuatuZambiaOther

5b. Please list your country of residence here:

6. Commonwealth Region:*

---AfricaAsiaCaribbean and AmericasEuropePacificN/A

7. If you are applying for CCYDN International Associate Executive Committee positions your Country of Residence must be outside the Commonwealth.
Confirm your Country of Residence

Contact Details

8. Email Address:*

9. Whatsapp - Mobile Number (Please include + Country Code):

10. Contact Number (Please include + Country Code):*

11. What type(s) of disability / impairment(s) do you identify as having?:*

Blind / Vision ImpairedDeaf / Hearing ImpairedDeafblindnessPhysical ImpairmentsChronic IllnessIntellectual or cognitive disabilityNeurodiversity (E.g. Autism, ADHD)Other

11b. Please provide any additional details regarding your disability

12. Your Access Needs

Please explain how your disability affects your access needs which need to be accommodated for the interview and if you are successful in becoming a CCYDN Executive Committee Member.

13. Are you a member of Youth Disabled Persons Organisation (YDPO), Disabled Persons Organisation (DPO), Organisation of Persons with Disabilities (OPD), Non Governmental Organisation (NGO), disability related groups, networks or forums?*

YesNo

14. Which position are you applying for?

14a: 9 CCYDN Executive Committee positions disabled youth from the Commonwealth

Policy and Research LeadAdvocacy and campaigning LeadCommunications and Information LeadEngagement and Capacity Building LeadMembership and Partnerships LeadFundraising and Development LeadCaribbean Regional RepresentativeEurope & Americas Regional RepresentativePacific Regional Representative

14b:
3 CCYDN Associate Executive Committee positions disabled youth from the Commonwealth aged 29 to 33 years

14c:
3 CCYDN International Associate Executive Committee positions disabled youth not from the Commonwealth aged 18 to 33 years

14d. What skills and experience do you have in the position you have chosen?* (Up to 500 words)

15. What issues are you passionate about or interested in supporting for children and young people’s disability rights, inclusion, participation and representation?* (Up to 300 words)

CCYDN Committee Work Themes

16. Which work theme or themes would you be interested to deliver and contribute in?*

(You can choose more than one)

Inclusive Education, Lifelong LearningEconomic Empowerment and EmploymentGender EqualityEnding Stigma, and Taboos associated with disabilitiesSafeguarding, Ending all forms of harmful practiceHumanitarian action and climate changeInclusive health and social careInclusive Sport and Recreation

17. What skills and experience do you have for the work theme(s) you have chosen?* (Up to 500 words)

18: Do you have particular skills/experience in any of the following areas? (You can choose more than one)

AdvocacyLeadershipTraining / Capacity BuildingPeer or Mentor supportEvent organisingOrganising and delivering campaignsProject managementPublic speakingSocial media administrationWriting reports /articles

18b: Provide Examples (Up to 400 words)

19: Do you have other skills, experience or attributes that you feel would assist and benefit CCYDN? Can you give provide details:

20: Although CCYDN Committee members time is voluntary, they are expected to commit ongoing time to CCYDN workplan and strategic goals. If selected, how much time would you be able to commit to?

2 hours a week3-6 hours per week6-10 hours per week6-10 hours per month minimumMore than 10 hours per month

21: Being part of CCYDN there are opportunities to be a representative in themed working sub groups, public events, forums, conferences etc. and contribute to reports, research and campaigns would you be interested in this?

YesNo

22: Optional Video submission.

We are also welcoming submission of video with application. Video submission is optional.

Would you like to submit a video with your application?

YesNo (This is your choice and it's okay if you do not want to)

22: To complete the application you will need to upload the following documents:

• CV / Resume and to include contact details of two referees (with most relevant information relating to position applied for max 2 pages)
• Optional Work samples including written samples / Showcase on previous work completed by you (max 2 pages)

If you have any issues uploading files, you can also email these to ccydn@includemetoo.org.uk
Please ensure the email subject starts with "CCYDN EXCO Application - Full Name"

Please check you have completed the form and we will be in touch with further information.

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