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* 1. Full name

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* 2. Gender identity

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* 3. Preferred pronouns

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* 4. Date of birth

Date

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* 5. Contact phone number

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* 6. Address

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* 7. Email address

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* 8. Would you tell us a bit about yourself and your lived experience of disability?

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* 9. Why would you like to join this Advisory Panel?

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* 10. What knowledge and skills do you bring to the role of representing the issues, needs and wants of people with disability?

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* 11. What are your areas of interest in regards to your participation?

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* 12. Are you currently using a service provided by Yooralla? If so, which one/s?

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* 13. Have you used a Yooralla service in the past? If so when and which one/s?

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* 14. If you are not a current client of Yooralla, what is your connection or interest in Yooralla?

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* 15. Do you identify as

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* 16. What is your country of birth?

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* 17. Describe your cultural Identity

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* 18. Is English your first language?

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* 19. Do you require an interpreter?

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* 20. What supports do you need to help you to participate, if any?

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