Community Engagement

Volunteer Application Form

Thank you for your interest in ANZGOG’s Community Engagement program. Please fill in the application form below and an ANZGOG staff member will be in contact

ANZGOG COMMUNITY VOLUNTEER APPLICATION FORM

VOLUNTEER APPLICATION FORM – Part A

Personal Details

Full Name

First

Last

Phone

Street Address

Suburb

State/Region

Postcode

Country

Gender

Do you identify as First Nations?

If yes, please specify:

Do you identify yourself as being from a Culturally and Linguistically Diverse background (CALD)?

If yes, please specify:

What is your motivation for joining the Community Engagement Program?

Your Lived Experience

The following information is held in strict confidence and is only used to assist us to support you in your participation in this program.

Please select the relevant gynaecological cancer type:

If other, please specify:

What is your experience with the disease ticked above?

Please provide the date and stage of your diagnosis or your loved one’s diagnosis:

If your experience is as a caregiver, please select the most appropriate option which summarises your experience:

If your experience is as a patient, are you currently in treatment?

*Research volunteer roles are not available for patients undergoing first line treatment. Education and Advocacy roles are available during all treatment periods.

Have you participated in a clinical trial?

If yes, please specify

Emergency Contact

Person to notify in case of emergency

Name

First

Last

Phone

Street Address

Suburb

State/Region

Postcode

Country

Relationship

Promotional & Other ANZGOG Activities

I would like to be kept informed about events and other opportunities to share my lived experience.

I give my consent for approved photographs and video recordings of me to be used for promotion of the Community Engagement Program.

I would like to be kept informed about ANZGOG research activities.

I would like to learn more about additional volunteering opportunities within ANZGOG if they arise?

ANZGOG COMMUNITY VOLUNTEER APPLICATION FORM – Part B

Your Area of Interest

Please select your priority interest area in the Community Engagement Program:

Research

Have you undertaken any formal consumer training? (Note: previous training is not a requirement.)

If yes, please list what you have done and where.

Are you currently involved with a consumer organisation and/or acted as a consumer representative on a committee or board?

If yes, please name the organisation, describe your role and include recent activities you have carried out.

Do you work for any health or research institutions?

If yes, where?

Do you have previous experience in reviewing research grant applications?(Note: previous experience is not a requirement.)

If yes, please describe your experience.

What qualities and life skills would you contribute to ANZGOG’s research?

Advocacy

Have you previous public speaking experience?

If yes, please give a brief description of your previous experience

Do you have previous experience in an advocacy role? (No prior experience does not exclude you from the role as training will be provided.)

If yes, please give a brief description of your previous experience

Have you undertaken any formal training in advocacy? (Note: previous experience is not a requirement.)

If yes, please list what you have done and where.

Please summarise why you would make a good advocate for ANZGOG. (Please note personal qualities, skills, qualifications etc. that you think would be relevant to an advocacy role.)

Education (Survivors Teaching Students)

Please mark the role(s) you are applying for:

Presenter

Facilitator

Regional Coordinator

Do you have previous volunteer experience?

If yes, please summarise.

Please outline any special skills or qualifications you have acquired from employment, or through other activities, that you think would be relevant to your volunteering with Survivors Teaching Students.

Have you publicly shared your lived experience of gynaecological cancer before? (Note: previous public speaking experience is not a requirement.)

If yes, please describe your experience.

Signature (Please type name)

Date

If you are human, leave this field blank.

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Engaging the community to help shape our research

Expanding the reach, relevance and impact of our research

Catalysing innovative, practice-changing research

Collaborating locally and globally, sharing expertise and insights

Sustain a vibrant and efficient research organisation

Volunteer Application Form

VOLUNTEER APPLICATION FORM – Part A

Personal Details

Your Lived Experience

Emergency Contact

Promotional & Other ANZGOG Activities

ANZGOG COMMUNITY VOLUNTEER APPLICATION FORM – Part B

Research

Advocacy

Education (Survivors Teaching Students)

Useful Links

Research

Advocacy

Education