Skip to content
1.
Name
(Required.)
2.
Pronouns
She/Her
He/Him
They/Them
Other (please specify)
3.
Email
(Required.)
4.
Phone number
(Required.)
5.
Postcode
(Required.)
6.
State/Territory
(Required.)
ACT
NSW
NT
SA
QLD
TAS
VIC
WA
7.
Organisation (if applicable)
8.
Organisation role (if applicable)
9.
Do you have access to a computer, tablet, laptop with internet access and camera so you can participate in video conferences?
(Required.)
Yes
No
10.
Target Groups: Do you have experience in or identify as any of the following target groups?
Select all categories that apply:
(Required.)
Aboriginal and Torres Strait Islander people living with MS
Culturally and linguistically diverse (CALD) people living with MS
People living with MS or carers of people living with MS who are currently receiving aged care services
Men under 50 years living with MS
Carers of people living with MS
People living with neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody disorder (MOGAD)
People living with MS who have expertise in nutrition
People living with MS or carers of people living with MS
11.
Do you have lived experience, or are you a carer/family member of someone with lived experience across the following categories?
Select all categories that are relevant to your experience:
(Required.)
National Disability Insurance Scheme
Aged care
Mental health
Employment, training and the labour market for people living with MS
Government income support such as the Disability Support Pension
Social and economic barriers facing people living with MS
Medical research
Assistive technology
Accessible, disability or social housing
Other (please specify)
12.
Which areas of interest or expertise would you feel most confident contributing to on the LEEP? For example, carer experience, navigating government services, participation in MS research, social and economic barriers.
Suggested length: 150 words.
(Required.)
13.
Why are you are interested in joining MS Australia’s Lived Experience Panel?
Suggested length: 150 words.
(Required.)
14.
Please list skills and experiences you have that would support the LEEP to strengthen advocacy, research and education for the MS community?
Suggested length: 150 words.
(Required.)