DA Champions Application

Domestic Abuse Champions Application Form

About You

Your Name(Required)
IMPORTANT By adding your manager's email address, you are confirming that you will take up a place on this course with thier consent. Your manager will be notified if you do not attend without previous cancellation of you place, Thank you.
Your Email Address(Required)

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)
NIDAS Newsletter(Required)
Please indicate if you consent to receiving the NIDAS newsletter and correspondence that contain updates about relevant services.