Personal information

Expression of interest form

CIRCA Research is looking to grow its network of research consultants. We welcome people from culturally and linguistically diverse (CALD), Aboriginal and Torres Strait Islander and disability backgrounds.

If you want to join our network, please complete the form below.

Need help filling out this form?

If you need support, you can call the CIRCA team on 02 8585 1325. We can help you complete this form over the phone.

Personal information

Given name *

Family name *

Preferred name

Mobile *

Telephone

Email address *

Address

Suburb *

State *

Postcode *

Postal address (if different)

Suburb

State

Postcode

Your gender *

Do you identify as Aboriginal, Torres Strait Islander or both? *

If Aboriginal and/or Torres Strait Islander, to which Aboriginal and/or Torres Strait Islander communities are you connected *

To help us understand your connection to the disability community, please select all that apply: *

I identify as a person with a disability.I am an unpaid carer for a person with a disabilityI am a paid disability support workerNone of the above.Prefer not to say

What disability (ies) do you identify with? *

Which disability(ies) have you supported most as an unpaid carer or paid disability support worker? *

What is your cultural background? *

Where were you born (country or place of birth)? *

What language(s) do you speak? Please tell us the languages you are fluent in. *

What is the highest level of education you have completed? For example, PHD, Diploma, Certificate IV *

What type of qualifications do you have? For example, Diploma of Community Services, Nationally Accredited Mediator, Facilitation Certificate

How did you hear about CIRCA?

Your skills

If you have other skills or expertise not listed above relevant to research work, please outline them here:

Have you run focus groups, interviews or meetings online? For example, Zoom, Google Meet or Teams *

In urgent situations, would you be willing to complete projects with a fast turnaround? For example, a project where you would only have 5 days to recruit participants and run a focus group or interview? *

Please list any trauma-informed interviewing experience you have. For example, experience with homelessness, mental health, domestic violence

Current work status

Please select the option that best describes you: *

Availability

Please select the boxes most relevant to you: *

Available during the weekday between 9am – 5pmAvailable during the weekday after 5pm Available during the weekend between 9am – 5pmAvailable during the weekend after 5pm

Availability to travel

Please list the places or communities you can travel to, or the furthest distance you are willing to travel for research work.

Please upload your current CV below.

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We will contact you shortly.

Thank you,

CIRCA Research Team.

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