TECS EOI

Personal Information

*Please note that your information will not be shared or disclosed than as described in our Privacy Policy

First Name *

Last Name *

Gender *

Mobile Number *

Email *

State *

Region *

Suburb *

Postcode *

Please answer the following questions

Please tell us about your role/position (if applies):

Which of the following categories you will be representing? You can choose more than one category

Community Leader

Community Group Name *

Faith Leader

Faith Group Name *

Service Provider

Organisation Name *

Community Organisation

Community Organisation Name *

Victim-survivor of family, domestic and sexual violence

Research Institution

Institution Name *

Other (Health, Legal, etc)

Please Specify *

My preference for participation in the TECS project (Tick all that apply) *

OnlineIn-personOne-on-oneDo not have a preference

I am interested in participating in (Tick all that apply) *

Consultation Workshop OnlyConsultation and Co-DesignCo-Design Only

I will require an interpreter *

YesNo

Language Requested *

I will require reasonable adjustments to assist with my participation. *

YesNo

Adjustments Requested *

Declaration

I declare that the information provided in this expression of interest form is accurate to the best of my knowledge *

YesNo

*Please note: By providing the Expression of Interest you consent to SSI, handling, using, and disclosing your personal information, including ‘sensitive information’ in accordance with our Privacy Policy. The SSI Group’s Privacy Policy explains how your personal information will be managed at SSI Group, how you can access and amend it, how you can make a complaint if you feel your privacy has been breached and how SSI Group will deal with complaints. It can be found via ssi.org.au/privacy

Captcha Challenge *

Project

Function

Stage