PANDA Community Champions Application

Thank you for your interest in becoming a PANDA Community Champion. All Community Champions must have had a personal experience of, or supported a partner or family member experiencing perinatal anxiety and depression or postpartum psychosis. Please note that in completing this form you are not giving permission for your details or story to be shared or used in any manner. The information you provide will be used for recruitment purposes only.

About You

Salutation

First Name

Last Name

Occupation

Mobile

Website/Blog

(if applicable)

Address Line 1

Suburb

State

Postal Code

Are you a current PANDA Volunteer?

YesNo

Are you a parent?

YesNo

If yes what age/s are your children?

Do you have any personal or professional skills you would like to share as a PANDA Community Champion?

What is your motivation for becoming a PANDA Community Champion?

How did you hear about PANDA's Community Champions Program?

Current Community ChampionE NewsFriendOther *(please describe)PANDA Social MediaPANDA Website

* (please describe)

Your Experiences

How has perinatal anxiety & depression effected you?

I experienced anxiety during pregnancyI experienced depression during pregnancyI experienced anxiety post birthI experienced depression post birthI experienced postnatal psychosisI supported my partner who experienced perinatal anxiety and/or depressionI supported a family member who experienced perinatal anxiety and/or depressionI supported my friend who experienced perinatal anxiety and/or depression(Please tick - you can tick more than one)

Have you contacted PANDA’s National Helpline for support?

YesNo

When was your most recent experience of perinatal anxiety and/or depression?

0 - 6 months ago6 - 12 months ago1 - 2 years ago2 + years agoNA

Please tell us about your perinatal anxiety and depression experience/s (ie symptoms, personal impact, treatment & support, recovery)

Max 750 characters

Community Champion Activities

Which Community Champion activities are you interested in?

Sharing your Story

Sharing your story of perinatal anxiety/depression on PANDA’s websiteSharing your story of perinatal anxiety/depression through online and traditional mediaSharing your story of perinatal anxiety/depression via PANDA’s social media posts

Media

Initiating local media activity (eg local papers, talkback radio)Sharing PANDA social media messages

Community Awareness

Running local awareness raising activitiesRepresenting perinatal anxiety and depression and PANDA to local community groups, organisations and governmentProviding a consumer voice within the community and perinatal health sectorPromoting PANDA ‘campaigns’Distributing PANDA resources to local community services and organistionsKeeping PANDA informed of relevant local activities, issues and perinatal support services

Community Fundraising

Hosting fundraising activities (eg. Lunch Out Loud)Promoting PANDA fundraising campaignsIndividual fundraising activities (eg marathon, walkathon, pram walks)

Reading, Writing and Research

Providing comment and input about new PANDA resources and projectsParticipating in perinatal mental health research projectsWriting pieces for our website or social media postsProof–reading PANDA resources /papers

Other ideas you may have for Community Champion activities