Psychological Support Form

1Full name*

2Age*

3Gender*

4Current place of residence (city name)*

5Academic qualification*

6Specialization*

7Years of experience*

9Experience in the field of artificial intelligence*

10Your current occupational status*

11How ready and willing are you to actively participate in planning and implementing the unit's activities?*

12Do you have any special circumstances or needs you would like to inform us of?*

YesNo

13If yes, please write here

14Contact number*

15WhatsApp number*

Section 5: Official Acknowledgment & Commitment

* Mandatory Acknowledgment

I declare that the information provided in this form is true and accurate, and I pledge to abide by the regulations and instructions of the Palestinian Smart Youth Parliament, maintain confidentiality and privacy, respect professional ethics in mental health and psychosocial support, and not use the name of the unit or parliament in any activity without official authorization.

Section 5: Official Acknowledgment & Commitment

Smart Palestinian Youth Parliament

Psychological Support Form

Section 5: Official Acknowledgment & Commitment