Jnetics on Campus
Student Reps

We are looking for Jnetics on Campus Student Reps!

"*" indicates required fields

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

Name*

Title First Last

Date of Birth*

Mobile*

Email*

Home Address*

Street Address City County Postcode

University Address*

Your address while at University.

Street Address City County Postcode

University/Higher Education Institute*

Year of Study*

Student ID*

University Course*

Have you been tested through Jnetics before?

Yes

Where and when were you tested?

Are you involved in your university JSoc?*

Yes

As a rep, how would you help Jnetics to raise awareness of Jnetics on Campus University Screening Week and encourage students to sign-up?*

What is your availability to meet with a member of the Jnetics team?