Brent Climate Emergency – Planning Group Registration Form

Name*

What is your gender?*

If other, please specify*

What is your age?*

What is your ethnicity*

If other, please specify*

What is your religion or belief?*

If other, please specify*

What is your sexual orientation?*

If other, please specify*

Do you consider yourself to be disabled?*

Under the Equality Act 2010 you are disabled if you have a long-term physical or mental impairment, which affects your ability to carry out day-to-day activities.

Please describe the type of disability (i.e. physical, sensory)*

Email Address*

Post Code*

What would you like to apply for?*

Please write a few words on why you would like to be involved in the planning group*

We are looking for a diverse group of residents who reflect the people of Brent. We are particularly keen to hear from people who don't ordinarily engage with the Council or who have never been part of something like this in the past. So please take a few moments to either send us in a short film about why you would like to be part of this, or write us a few words (no more than 250) about what makes you want to take this step forward.

Accepted file types: mp4, mov, wmv, webm, Max. file size: 150 MB.

GDPR statement on how we use this data
The data collected above is only seen by MutualGain, this is to create a fair and diverse selection process. The information you provide will not be shared with any third parties. However, if at the end of the events you wish to share this information with the council, to keep you informed of future engagement opportunities you will have the opportunity to do so. If not, we will delete this information within 6 weeks of completing the selection process.

Phone

This field is for validation purposes and should be left unchanged.