Expression of Interest Application
Thank you so much for showing interest in participating in a lived experience program delivered by Roses in the Ocean.
Once you have completed this form, and in doing so, registered your interest to attend this program, you will be contacted by a member of the Roses in the Ocean team when we have a program running in your area. We will have a conversation about our programs, answer any questions you may have and discuss your readiness to be involved. It is an informal chat to ensure that this is the right opportunity and the right time for you to be involved.
This form will enable you to register to participate in a one or more of our Lived Experience programs or specify a program you may have seen on our Facebook page or website. We highly recommend you also like our facebook page and sign up to our quarterly newsletter (via our website homepage) to stay abreast of opportunities around the country.
The information you provide in this form will be used for the purposes of Roses in the Ocean discussing your readiness to be involved and for pre and post program communication. You have the option at the end of this form to indicate if you consent for this information to be shared with the organisation who has supported this training opportunity.
Please ensure you have read the ‘Readiness to be Involved in Suicide Prevention’ document before completing this Registration which you can find on our website
under the Lived Experience/Forms page.
Should completing this form raise any strong emotions for you, and you'd like to speak with someone, here are some National Helplines:
Lifeline 13 11 14
Suicide Call Back Service 1300 659 467
QLife 1800 184 527
You can find further helplines and avenues of support through the Everymind website here
Year of Birth
Best contact number
Alternative contact person
As your safety is our main concern we would like to have a trusted alternative contact for you. In the event that we need to contact a support person for you or are having issues contacting you, we know who to call. Please include their name, relationship to you, and their contact details such as mobile and email.
Name of alternative person
Phone number of alternative person
Relationship to alternative person
Do you identify as a member of any of these groups?
Aboriginal or Torres strait Islander
CALD: Culturally and Linguistically diverse
LGBTI: Lesbian, Gay, Bisexual, Transgender and Intersex or other diverse sexuality
Please select all that apply to your lived experience
I have had suicidal thoughts
I have survived a suicide attempt
I have cared for someone who has been suicidal and/or attempted suicide
I am bereaved by suicide
Briefly describe your lived experience (we ask that you do not disclose method in your description).
Briefly explain what you hope to achieve by attending the lived experience workshop?
Is there any particular role you see yourself doing within suicide prevention? eg speaking publicly, advocating, volunteering at events, reference group member.
Describe what you do on a daily/weekly basis to nurture and take care of yourself.
Do you currently access counselling to maintain balance/stability?
Please read each statement and indicate your agreement before submitting your application.
I understand that my participation will be dependant upon places being available
I have read the document “My readiness to engage in Lived experience activities”
I will be contacted by Roses in the Ocean when there is a program in my area
I believe that I'm currently well and that getting involved will not cause me harm
As per our policy guidelines we will ask your permission before sharing your private information, we will not use your information for marketing purposes unless prior permission has been given by you, and you are able to withdraw any permissions, or request access to your information at any time by writing to the Privacy Officer at
We are seeking your permission to share your information in the following ways (by ticking the box you are agreeing to us using your private information and images):
I give permission for Roses in the Ocean to share the contents of this form with the organisation funding this program
I give permission to be included in a group photograph during the program for promotional purposes
Do you have any dietary requirements?
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