Stonewall Young Leaders Programme
13 - 15 December 2017
Please read our Guidance Notes on our website before you start completing this form
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About you

If you would like a plain text version of this form please email
Full name *

Organisation *

Job title *

Work address *

Telephone *


What best describes your gender? *

If you prefer to use your own term please state here:

Is your gender identity the same as the sex you were assigned at birth? *

What is your sexual orientation?

If you prefer to use your own term please state here:

How old will you be on the 13 December 2017? *

The Young Leaders programme is for 18 to 25 year olds.

Do you have a disability?

Which best describes your ethnicity? *

What is your religious belief? *

Programme Application Questions

Why would you like a place on the Stonewall's Young Leaders programme? *

In your opinion, what is the relevance of sexual orientation and / or gender identity in the workplace? *

Where do you have influence within your organisation and/or employment sector. *

How do you think this programme will impact your organisation? *

Your programme mentor

Who will be your programme mentor?

This does not need to be your first or second line manager.
Mentor's name

Mentor's job title

Mentor's organisation

Financing your space

If your application is successful how will your space be financed? *

The Young Leaders programme is a great personal and professional development opportunity and many organisations will be keen to finance spaces for their employees. However, if your employer is unable to fund your application, let us know in your application as we may be able to help.

Employer contact name

Answer only if your employer has agreed to finance your space. This should be the person who is authorising your application.
Employer contact's telephone

How did you hear about the Stonewall Young Leaders programme? *

Please upload a recent copy of your CV

Thank you for applying for a space on Stonewall's Young Leaders programme

The closing date for applications is 27 October 2017. We will inform you of your application's outcome a few days after this.