2022 Safer Internet Day Ambassador Application Form

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電子郵件 *

Name *

Date of Birth *

YYYY

Tel Number *

Email Address *

Home Address Line 1 *

Home Address Line 2 *

City *

County *

Eircode *

Name of Parent/Guardian *

Parent/Guardian Tel Number *

Name of School *

School Address Line 1 *

City *

County *

Eircode *

School Principal *

We recommend that you have a teacher to help you run a campaign. Please give the name of the teacher who will assist you and coordinate your participation in the training programme. *

Email address of nominated teacher *

Full attendance and participation is required in each training meeting. This requires access to a wi-fi enabled device with a camera and microphone. Please confirm you will be able to fully participate in the programme. *

I confim I can participate in each online training meeting with a wi-fi connected device with a working camera and microphone for me to participate.

I will not be able to participate and attend each training meeting.

必填

Provide details of any relevant experience you have with awareness raising in your school/community/youth group. (Please note experience does not have to be related to internet safety). *

Tell us why you would like to become a Safer Internet Day Ambassador? (50-100 words) *

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