DA Champions Application

Domestic Abuse Champions Application Form

About You

Your Name(Required)
Your Email Address(Required)
MM slash DD slash YYYY

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
  • Cascade the newsletter and any updates to their teamMaintain 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)
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