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DA Champions Application
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2024-09-20T09:18:31+00:00
DA Champions Application
Domestic Abuse Champions Application Form
About You
Your Name
(Required)
First
Last
Role
(Required)
Organisation
(Required)
Manager's name
(Required)
Manager's email
(Required)
District you are based in
(Required)
Breckland
Broadland
Great Yarmouth
Norfolk wide
North Norfolk
Norwich
South Norfolk
Tel
Mobile
(Required)
Your Email Address
(Required)
Email Address
Confirm Email Address
The Domestic Abuse Champion agrees to:
Attend the full two days DA Champions Training
To attend at least one network event annually
Pass information between their agency and the Champions network
Maintain up to date information in relation to available services
Ensure domestic abuse materials are displayed within their agency
Contribute to the development and effectiveness of the Champion network
Information being shared around attendance at the training sessions, with line managers
The organisation agrees to:
Support the champion in spreading awareness of domestic abuse and its impact, response to disclosures, and sources of support
Enable the champion to have time to attend networking events and training
Provide an environment that encourages disclosures of domestic abuse and provides information about support services
Facilitate the champion cascading learning and information to the organisation and sharing this with colleagues
Support and encourage the champion with their responsibilities
Data Sharing Agreement
I understand that my information will be kept in Leeway’s internal database. Leeway Domestic Violence & Abuse Services will use your information for the following purposes:
to collect statistical information
Share collected data with NIDAS Partners, other Domestic Abuse Champions/Your Agencies /Commissioners and Funding Partners
to keep a working record of our involvement with you
to help evaluate the work that we do
You can withdraw permission to use your personal information at any time by contacting dachampions@nidasnorfolk.co.uk You have the right to ask us what information we hold about you, to do this please contact admin@leewaynwa.org.uk
Data sharing agreement
(Required)
If you consent to the above data sharing agreement, please tick here
NIDAS Newsletter
Please indicate if you consent to receiving the NIDAS newsletter and correspondence that contain updates about relevant services.
Yes
No
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