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Coastal Community Leaders 2024 Application Form
Please complete the form below and click 'Submit' to apply to the program. All responses will be kept in full confidentiality. We will aim to respond to you within 48hrs. Any questions, contact christian@pebl-cic.co.uk
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Date of birth
MM
/
DD
/
YYYY
Contact phone number:
Your answer
Gender
*
Male
Female
Non-binary
Prefer not to say
Other:
Ethnicity (optional):
*
White
Mixed/Multiple ethnic groups
Asian/Asian British
Black/African/Caribbean/Black British
Prefer not to disclose
Other:
Which area of Holyhead or its surroundings do you live in?
Your answer
What is your current education, care or work status?
Unpaid carer full-time (includes childcare)
Unpaid carer part-time (includes childcare)
Paid employment full-time (includes self-employed)
Paid employment part-time (includes self-employed)
In education full-time (school, college, university, apprentice, other training)
In education part-time (school, college, university, apprentice, other training)
Unemployed
Retired
Other:
Have you participated in any environmental programmes or initiatives before?
Yes
No
Clear selection
What days are you available to attend the workshops?
Saturday 3rd Feb 10am - 2pm
Sunday 4th Feb 10am - 2pm
Sunday 3rd March 10am - 4pm
Saturday 6th April 10am - 2pm
Sunday 7th April 10am - 2pm
Please indicate any skills or experiences you think are relevant to the programme (300 words max)
Your answer
What do you hope to achieve by the end of the programme?
(300 words max)
Your answer
Do you have any dietary restrictions?
None
Vegetatian
Vegan
Gluten-free
Halal
Other:
Clear selection
Do you require any special accommodations or support to participate in the programme? If yes, please specify.
Your answer
The project team will conduct the program in English. We can provide translation services if you require them. Please indicate your language preference below.
I am comfortable with the program being delivered in English.
I would prefer to have a Welsh translator present.
Other:
Clear selection
How did you hear about the program?
Poster
Social Media
Word of mouth
School/University/Employer
Other:
Clear selection
Press submit to you send your application. A confirmation email will be sent to you upon submission.
A copy of your responses will be emailed to the address you provided.
Submit
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