Registration: Newham Young Black Men's Leadership and Engagement Programme

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By submitting this form, you agree to the collection and storage of your information for the Newham Young Black Men's Leadership and Engagement Programme.

Your data will be used solely for project-related activities and communication, handled confidentially and in compliance with data protection regulations. If you do participate in the Newham Young Black Men's Leadership and Engagement Project, you consent to the use of your information in project materials.

For additional information and/or data concerns please feel free to contact: ankhplace@gmail.com

Email *

Record my email address with my response

First Name *

Surname

Email Address

Contact Number

Age (This programme is targeted at young black men) *

18-20

21-25

26-30

Do you live, work or study in Newham? (All applicant must either live, work or study in Newham to participate) *

Yes, I LIVE in Newham

Yes, I WORK in Newham

Yes, I STUDY in Newham

Which Newham postcode do you live, work or study in? *

E12

E13

E15

E16

E20

What is your Ethnicity?

White British - White Irish

White Irish

White European

Black or Black British - Caribbean

Black or Black British - African

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Chinese

Mixed - White and Asian

Mixed - Black and Asian

Mixed - White and Black Caribbean

Mixed - White and Black African

Prefer not to say

Clear selection

What is your Gender?

Male

Non-Binary

Prefer not to say

Clear selection

Do you have any special needs, disabilities or communication needs?
*

Yes

Prefer not to say

If you answered "Yes" to having any special needs, disabilities or communication needs, please let us know about them here:

Family demographics:

Single-parent household

Two-parent household

Foster care child

Refugee or migrant background

Blended/step family

Other

What is your current occupation?
*

Student

Employed (full-time or part-time)

Unemployed

Self-employed

Apprenticeship/Traineeship

Freelancer

Volunteer

Unpaid intern

Full-time Caregiver

Other

Please state any skills, experiences or expertise you have that would be helpful to this programme here:
*

Where did you hear about the project?

Data Protection Consent - By checking this box, I confirm that I have read and understood the data collection and usage terms provided in the consent statement. I consent to the collection, storage, and use of my information for the purposes outlined in the statement.
*

Yes, I consent to the collection and usage of my information as described.

Required

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