One year, many women Taking it to the community: talking health with Victorian women

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Antony Poole
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1 Introduction One year, many women Taking it to the community: talking health with Victorian women Thanks to funding from the Eirene Lucas Foundation, Jean Hailes is pleased to offer a unique opportunity for Victorian communities to invite a Jean Hailes speaker to present on women s health at an event they are organising in their local area. This new project enables ten Victorian organisations working in women s health with marginalised communities to access an expert speaker to deliver a presentation that addresses local health information needs. Before you complete this application form, please ensure you have carefully read the Expression of Interest information sheet. You can access this form via the Jean Hailes News page on our website. Organisation details * 1. Organisation Contact name and position title Organisation Address Address 2 City/Town State Postcode Address Phone Number

* 2. Local Government Area * 3. Is your organisation not-for-profit or publicly funded? * 4. Have you previously participated in a Jean Hailes event? e.g. community webinar/women's health week event If yes, please provide details of previous event/s Community details * 5.

2 * 2. Local Government Area * 3. Is your organisation not-for-profit or publicly funded? * 4. Have you previously participated in a Jean Hailes event? e.g. community webinar/women's health week event If yes, please provide details of previous event/s Community details * 5. Your community Please tell us about the health needs of the group/s you are hoping to reach with this event, and why a community event approach has been taken. You may like to include information from your municipal health plan, local Primary Health Network needs assessment or what your own experience and work has identified. *If you have documents you would like to provide in addition to, or that support your responses, you can attach them at the end of the application form. If you are sending larger documents, please highlight the relevant parts so we know what you would like to draw our attention to.

3 * 6. Your organisational capacity Please tell us about your organisation and your experience, if any, in coordinating similar events. We'd love to hear examples of these events or activities and what worked well to make them successful Event details * 7. Proposed date and time of event * 8. Is this date/time flexible? Comments * 9. Event Outline Please provide a brief outline of the event including the event purpose, how it addresses local health needs, speakers and other organisations involved.

4 * 10. Promotional and engagement activities Please describe how your target group and local community will be encouraged to participate? i.e how will you promote the event? How will you involve local service providers? Will local media be alerted? * 11. Presentation topics Please choose your top three preferences and use the space below if you have additional topic needs. Please note, depending on the topics and the speaker, we may be able to cover two topics within the one presentation. To find out more about these topic areas visit the Jean Hailes website. Bladder & bowel health including continence Bone health Breast health Cardiovascular health Emotional health and wellbeing e.g. depression, anxiety, stress Endometriosis Fertility and pregnancy Health checks and screening Healthy living e.g. nutrition, physical activity, behaviour change Menopause and/or perimenopause Perinatal mental health and early parenting Periods Polycystic ovary syndrome (PCOS) Sex and sexual health e.g. sexuality, contraception, libido Sleep Vulva, vagina, ovaries and uterus Other (please specify)

5 Audience details * 12. Audience Please provide some information about your intended audience and the group's demographics e.g. community members, staff, new parents, women etc Preference will be given to stakeholders working with women in areas of relative socio-economic disadvantage; women in rural and regional areas of Victoria, and/or women from culturally and linguistically diverse and Indigenous communities. Please include target age range here. Additional information *If you have documents you would like to provide in addition to, or that support your responses, you can attach them at the end of the application form. If you are sending larger documents, please highlight the relevant parts so we know what you would like to draw our attention to. * 13. Estimated number of attendees *Preference will be given to events with 40+ attendees 14. Any special requirements for the group or event?

6 * 15. Extra health professional session It may be possible for our speaker to provide an additional session for local health professionals at an extra charge. Are you interested in an extra session for your local health professionals? Please provide information on what session you would like for local health professionals. There will be a charge associated with this as it is not included in the funding agreement. Other * 16. If successful, I agree to complete an evaluation report supplied to me by Jean Hailes no later than 8th September 2017 * 17. If successful, the organisation agrees to promote the 2017 Jean Hailes women s health survey and Women s Health Week campaign within our networks 18. Additional information Use this space to provide other relevant information or comments related to your application.

19. Supporting documentation If you have a document you would like to provide to support your application, please attach it here. File size limit is 16MB Choose File file chosen 20.

7 19. Supporting documentation If you have a document you would like to provide to support your application, please attach it here. File size limit is 16MB Choose File file chosen 20. Supporting documentation If you have a document you would like to provide to support your application, please attach it here. File size limit is 16MB. If you have another document please it to fiona.darling@jeanhailes.org.au with Eirene Lucas - and your organisations name in the subject header. Choose File file chosen Thank you Thank you for your interest in this project and for completing the application form. Applicants will be notified by 31 March of the outcome. To receive updates, news and future opportunities such as this one, please subscribe to the Jean Hailes updates.

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