White Ribbon Community Partner Application

Declarations and Disclaimers

Please be advised that this application covers subject matter including men’s violence against women and sexual assault which may be triggering to some people. For specialist support for experiences of violence and abuse please contact 1800 RESPECT

You will also need access to your current Police and Working With Children Checks (WWCC), if required.

Please reserve roughly 20 - 30 minutes to complete this form.

Application Pre-requisites

Please upload your current Police Check from the last 6 months. If you do not have a current Police Check, please apply for one here.

We occassionally have speaker requests within schools which may require official approvals for working with children (such as Working With Children Checks (WWCC)). Do you have an active WWCC (or state equivalent)?

If yes, please upload your WWCC.

I do not have any past activity, speech or behaviour to disclose that may bring White Ribbon Australia into dispute by my involvement as a Community Partner.

Do you give permission for Communicare to share your contact details with White Ribbon committees or Action Groups

I have completed the White Ribbon eLearning Course.

I have read and understood the Code of Conduct. Please print the Code of Conduct and sign it. Then, upload it here.

I have read and understood the Role Description.

About You

Please be aware that White Ribbon holds any information given in accordance with the Privacy Act (1988) and will not share this information with a third party. Any data gathered may be used for evaluation purposes in a way that ensures anonymity and no identifying information will be used without consent.

Contact Details

First Name:

Surname:

Gender Identity:

Primary Email:

Secondary Email:

Preferred name:

Address:

Suburb:

State:

Postcode:

Mobile Number:

Date of Birth:

Do you have any accessibility or communication requirements we should be aware of?

Do you identify as being from an Aboriginal and/or Torres Strait Islander community?

How would you describe your cultural background?

Employment and Affiliations

Are you currently employed or in education?

Which organisation do you work for?

What your job title?

Work email

Work phone number

What sector do you currently work in?

Work Address

Suburb

State

Postcode

At which institution do you study?

Which course do you study?

Other useful skills and experience you bring:

Do you follow or belong to any professional networks, community groups or sporting groups?

Group/Network affiliations:

Are you a member of a White Ribbon Committee?

Which White Ribbon Committee do you belong to?:

Nominate a Referee

Please provide us with the contact details for a referee who has known you for a minimum of two years, and is not a family member, spouse/partner or employee/line report.

Referee's First Name:

Referee's Last Name:

Referee's relationship to you:

Referee's E-mail Address:

Referee's Phone Number:

White Ribbon and You

Why are you applying to partner with White Ribbon to work towards ending gendered violence?

How have you been active in your community to prevent, challenge and end men's violence against women, including any involvement with White Ribbon in the past? Please give examples:

Why do you think it is important to have a focus on engaging boys and men in the goal of preventing violence towards women?

What is your understanding of the cause or drivers of violence against women?

What are the areas of knowledge or skills you would like to learn more about regarding men's violence against women and gender equality?

Are you part of any groups or organisation that might have a conflict of interest with White Ribbon’s goals, vision and values of ending men’s violence towards women?

Do you have any reflections or feedback for us on this application process so far?

Filming and Photography	Public speaking	Workshop facilitation
Event Organising	Academic expertise	Corporate experience
Political experience	Media experience