Thanks for taking a few minutes (2–5) to tell us an impact story — your own, or something you saw or heard.

Stories will be used to evaluate, improve and report on our work and may be shared publicly to help others understand the impact of Life Ed.

Your response will be de-identified when used or shared with external evaluators (unless you give specific permission) or you can fill this out anonymously.

Your information is stored securely and handled under our Privacy Policy.

What happened?

Tell us what happened and how Life Ed’s work had an impact – in full sentences, like a short story if you can. You might like to include: WHAT happened - WHO/WHAT was impacted and HOW - WHY it matters and HOW Life Ed’s work contributed.

You may attach files to support your story if you like

Upload up to 3 files (30MB total) — such as:

- A copy of an article, email or letter describing the impact
- Photos of drawings, activities, projects or creations that demonstrate impact

- Notes or reflections from the session or other program activities

Do not upload photos or videos of children, or anything that identifies individuals - this is to protect their privacy.

JPEG, JPG, PNG, PDF, DOC, DOCX, MP4, ZIP

When did this impact or change take place?

This could be when the program took place or when the change or impact was first noticed. A best guess is fine!

Please specify which program/module

School Name

If the impact is related to a program delivered in a school/preschool, please let us know which one - include the suburb/town.

Other comments

For anything else you want to mention, or links you'd like to share (e.g. link to a public post, article or file) - note them here.

Q0. Internal Control - please leave blank

Is this impact or change still ongoing?

This helps us understand how sustained or ongoing the impact might be.

Yes — it’s still ongoingNo — it happened in the pastNot sure

Who was impacted in this story?

(Select all that apply)

Child/ Children Teacher / Educator (s)Parent / Caregiver (s)Other

Please specify

Consent for follow-up; Check the boxes if you agree with the below:

I am happy to be contacted in future for Life Ed evaluation or research purposes (e.g. interview, survey or focus group). I understand that if I say yes now, I can change my mind when contacted.

I am happy to be contacted by a Life Ed staff member if there is an opportunity to share my story publicly to help raise awareness or support for Life Ed.

Your Contact Details

Thank you for agreeing to be contacted about future opportunities. Please provide at least one way to reach you.

Name

Phone No

Email Address

bCyberwise	Decisions	Friends & Feelings
Growing Good Friends	Harold's Big Feelings	Harold's Friendship
Harold's Online World	Healthy Harold's Day	My Body Matters
Ready Steady Go	Relate Respect Connect	Safety Rules
Super Safe Harold	Take a Breath	Talk About It
The Inside Story	Think Twice	None / I'm not sure
Other