'Share Your Story': Success Stories

Template

If you, your organisation, regional eye stakeholder group or another collaboration are interested in ‘sharing your story’, please complete the online template below or alternatively download the Word version of the template and email it to IEH Indigenous-EyeHealth@unimelb.edu.au The following template is a suggestion and is meant to provide a guide with prompts to collect information to create the ‘story’.

Please share with us any quotes, photos, videos or supporting articles to go along with ‘your story’, and of course, we won’t publish any material until we have cleared it with you.

‘Your story’ will be displayed on IEH’s website and may be promoted in other IEH publications (newsletter, Twitter, Facebook etc.).

If you have any difficulties or questions when completing this template, please email IEH, Indigenous-EyeHealth@unimelb.edu.au or call (03) 834 49320

Download Word Template Media Release Form

Please fill in all the fields below and click the submit button when complete

Your Contact Details

Name *

Position *

Organisation *

Email *

Phone *

Are you happy for your contact details to be included at the end of the story? *

FORM SUBMISISON

Focus/theme of story: What is the focus/theme of your story?

Background details: What prompted the initiative - What is the data/community saying? Include relevant details like location/community/organisation/Indigenous population/language group etc. (if applicable)

Implementation: Details of implementation (what/who). Include any partnerships/collaborations. Was funding provided to support initiative?

Changes or Outcomes: Describe some of the changes or outcomes that were achieved

Challenges and Solutions: What were some of the barriers or challenges and how were they overcome?

Lessons learned: Describe the lessons learned. What were the key elements that made this a success? What are the future plans to further or continue this effort?

Supporting photos/images/logos and other attachments: Please only tick the box if you are answering YES to the question. We will follow up with you further if necessary.
^ Requires signed IEH Media Release Form

Do you have any specific quotes from individuals/stakeholders that would support your story?
^Do you have any photos/images/videos etc. (jpg file) to support details in your story?
Do you have any other attachments (newspaper articles, journal paper, other publication) to support your story?
Do you have your organisation’s logo/other stakeholder logos that you would like to add to support your story?