Youth Panel - Nomination Form

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* 1. Please confirm you have the nominees permission to nominate them for the 2022 Youth Panel:

Yes, I have their permission

No, I do not have their permission

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* 2. To nominate someone for the Youth Panel, firstly please provide your (the nominators) contact information:

First name

Surname

Phone number

Email address

How do you know the nominee?

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* 3. Please indicate which local government area that the nominee lives (if you are unsure, visit www.lgat.tas.gov.au).

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* 4. Please provide the nominees contact information:

First name

Surname

Age

Suburb/Town

Phone number

Email address

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* 5. Why would you like to nominate this person for the Youth Panel?

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* 6. What, if any, support do you think the nominee will need to get the most out of this opportunity?