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Family, Friends & Carers Reference Group — headspace Colac.

Group Member Application Form

About You

We’d love to get to know a little about you! Your insights and lived experience as a family member, carer or supporter of a young person are invaluable in helping shape headspace Colac’s services.

The information you share will help us understand the diverse range of voices, backgrounds and experiences across our community and ensure the Family & Carers Reference Group reflects the people and families we support.

All responses are confidential and will be used to help us understand your interests, experience and suitability for involvement in the Reference Group.

You don’t need to share anything you’re not comfortable with, please only provide information you’re happy for us to know. There are no right or wrong answers — we’re simply interested in hearing about you and what you might bring to the group.

Email: headspacecolac@barwonhealth.org.au or Phone (03) 5232 5520 for info & questions


1.What is your full name (include pronouns I.E SHE/HER) and preferred contact method (email and/or phone)? Please Provide below
2.Have you or your family member had any contact with headspace services? If yes, please briefly describe your experience.
3.What is or was your relationship to the young person you have supported (e.g. parent, guardian, sibling, carer, other)?
4.Why are you interested in joining the Family & Carers Reference Group?
5.What perspectives, experiences, or strengths do you feel you could bring to the group?
6.Are there any particular topics, issues, or areas of service you are most passionate about influencing?
7.Do you have any previous experience participating in groups, committees, or advocacy work?
8.How comfortable do you feel sharing your thoughts and experiences in a group setting?
9.What times or days would generally suit you to attend meetings?
10.Is there anything we can do to make participation easier for you (e.g. flexible attendance, accessibility needs, carer support, training or reimbursement preferences)