Change Makers EOI | www.womenstraumarecoverycentre.org

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Change Makers Collective Expression of Interest Form

The Change Makers Collective is a program for women with lived experience of domestic, family and sexual violence who want to use their experience to help create change. We welcome women who feel their voices have been marginalised included First Nations women, and those from a Cultural, Linguistically and Diverse backgrounds. We invite you to fill out the short survey below to register your interest and to reflect on readiness for the Change Makers Collective. If you have any questions please email MelindaF@womenstrc.com.au Your information and answers will be treated confidentially.

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you identify as Aboriginal or Torres Strait Islander:

Yes - Aboriginal

Yes - Torres Strait Islander

Neither

Prefer not to say

Affiliated Organisation:

We request consent to speak with your most recent support provider. We may utilise this to further discuss readiness or support needs.

Phone

PART 2 - Readiness self-reflection

The process of transforming experiences into lived expertise can be confronting at times. The following questions invite you to reflect on your current situation and goals.

What are you most hoping to get out of an advocacy-based program? Where would you hope to be in three years’ time?

Do you anticipate any challenges in drawing from your lived experience as part of an advocacy-based program?