Donate

Motherland Village Program Feedback

Thank you for taking part in Motherland Village. Please fill out this form after your final zoom call in week 6 of the program.

Your feedback helps us improve Motherland Village and demonstrate the impact of the program to our supporters and funding partners so we can continue providing support to rural mothers.

Name(Required)
What state do you live in?(Required)
This will only be used for gathering and analysing data for reporting purposes.
What were you hoping to get out of the program? you can select more than one(Required)
What did you gain from the program? – you can select more than one(Required)
What was your favourite part of the program?(Required)
Select as many choices as you like.
Please check the box if you learnt something from the Expert Videos(Required)
Please note which videos have led you to change something in your life.
Which was your favourite Expert Video?(Required)
Which was your least favourite Expert Video?(Required)
Did you enjoy the six weeks? What’s changed for you? What impact has the program had? *Please note if we use your testimonial for any marketing, we will include your name, age group, state and headshot if you provide your consent below.
Max. file size: 50 MB.
Have you read Seen Again and/or used your pack of High Low Buffalo Cards?(Required)
Would you be interested in helping us promote Motherland further?(Required)
This may include media opportunities to share your experience, or the chance to host a Motherland fundraiser in your region in the future.
Please note this may be used for reporting purposes in a de-identified way.
For reporting purposes, do you identify as:(Required)
Please note this response may be used for media and communication purposes, including social media and donor reporting. Please let us know if you’d prefer to remain anonymous.
If you were an Elders Scholarship Recipient, would you have joined the program without the scholarship?(Required)

By completing this survey, you understand and agree that:

  • Your survey responses will be used by Motherland to evaluate and improve the Motherland Village program.
  • Your personal information will be handled in accordance with Motherland’s Privacy Policy. We will take reasonable steps to protect your information and only use or disclose it for the purposes outlined here or where required by law.
  • We may use quotes or testimonials you provide in our marketing and communications, including on our website, social media, newsletters, funding applications and reports. We will only identify you by name if you have given us permission to do so.
  • We will share de-identified survey data, insights and participant feedback with current or prospective donors, grant providers, funding bodies and other stakeholders for reporting and evaluation purposes. This information will not identify you personally unless you have given us permission to do so.
  • Your participation in this survey is voluntary, but we really value your insights and constructive feedback.

If you provide information that suggests there is a serious and immediate risk of harm to yourself or someone else, or if we are otherwise required to do so by law, Motherland may need to take appropriate action in line with our safeguarding and risk management processes.

Thank you for helping us strengthen support for rural mothers across Australia.

Close