Survivor Council NI Consultation - Expression of Interest Form

NOTHING ABOUT US WITHOUT US.

EXPRESSION OF INTEREST FORM. Hosted by the Northern Ireland Survivor Council, supported by the Brave Movement and funded through the Domestic & Sexual Abuse Strategy Small Grant Scheme. Victim and Survivor-Led Consultation – End of January 2026.
Thank you for your interest in participating in our consultation event.

This consultation is open to all victims and survivors of Child Sexual Abuse (CSA) whether or not you have ever spoken publicly about your experience. We encourage parents of victims and survivors to attend too. Your insight and voice are deeply valued. The information shared through this event will be used to shape a collective proposal and policy recommendations that will be presented to the NI Executive, justice and health partners, and service providers at a Dissemination & Policy Event shortly after our consultation. You can take part in-person, by phone interview (limited places), or through an online survey. Every response helps us ensure that survivor voices shape real change in Northern Ireland. All data will be stored securely and anonymised in line with UK GDPR.
Name:

First NameLast Name
E-mail Address:*
example@example.com
Phone Number:
Format: (000) 000-0000.
Town/area that you live
Age range
Gender/Gender identity
Sexual Orientation
Ethnic or Cultural Background
Religion or Belief
YesNoPrefer not to say
Please describe any accessibility requirements.
In-personTelephone interview (limited availability - please add phone number above if you select this option)Online survey

Preferred timing for event? (proposed date for event is end of Jan, beginning of Feb 2026)

Rows	Daytime	Evening
Weekday
Weekend

Preferred event location. (a convenient location if you are attending the event in person - does not need to be in the town you live, ex: near your workplace or childcare.)
YesNo
Please provide details of support needed.
Dietary requirements.
YesNo
Preferred language.
How can we make the event more accessible or comfortable for you?
Yes - during the eventYes - after the eventNoNot sure yet
YesNoMaybe
Would you like information beforehand on self-care tools or grounding activities? Tell us what would be helpful.
Support and services - what helps, what doesn't, what's missing.Justice system - police, court, reporting, re-traumatisation.Barriers to disclosure - what stops people from reporting.Prevention and awareness - education, culture, early intervention.Inclusion and access - men, LGBTQIA+, minorities, disabled survivors.Other
If you ticked "other" please give details.
What issues most urgently need to change for victims and survivors in N.I?
If you could share one message with government, what would it be?
YesNo
YesNoNot sure
Confidentiality Statement

All information will remain confidential. You do not need to share identifying details. Data will only be used to contact you about this event and anonymised policy reporting.
GDPR Consent

I consent to my data being securely stored and used for:

·       Event planning and guest list confirmation

·       Anonymous data analysis for the survivor-led policy report

·       Sharing event details and updates
YesNo
If you would like your responses to be de-anonymised before inclusion in the dissemination report and event, please let one of us know when participating.
Is there anything else you would like us to know to support your participation or wellbeing?
Do you have any notes for event organisers?
Organisation or serviceSocial mediaWord of mouthOther
If you ticked "organisation or service" or "other" please provide details.
Should be Empty:

NOTHING ABOUT US WITHOUT US.

Thank you for your interest in participating in our consultation event.