Application Form
For Responding to Domestic Abuse Disclosures
Your name
*
First Name
Last Name
Your Address
Street Address
Street Address Line 2
Town or City
County
Post code
What's the best way to contact you:
Text/Phone/ Email
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
I consent to my information being shared for evaluation
Yes
No
This training is aimed at people who have a connection to local communities in Cambridge and the surrounding area. Please tell us about all your connections to the above area:
*
I work in Cambridgeshire
I volunteer in Cambirdgeshire
I live in Cambridgeshire
Other
Where do you interact with most people day to day?
Work, online, at home etc?
In what ways do you hope this course will benefit you?
*
Why do you want to be involved in the course?
*
General interest in domestic abuse
To gain skills relevant to future employment
To learn more about supporting people who have experienced domestic abuse
To begin a career within Domestic Abuse Sector
Someone close to me has experienced Domestic abuse
I have received previous training and want to know more
I have attended an awareness raising event
Other
How did you hear about us?
Cambridge Women's Aid is committed to making our training as accessible as possible. Please let us know how we can support you to get the most out of the training.
Interpreter? Captions? Etc
Would you take some time to complete our demographic information?
*
Please Select
Yes, please continue with questions
No, I don't want to fill it out
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How would you describe yourself
Man
Woman
Non-Binary
I'd rather not say
Other
Do you identify as Transgender?
Yes
No
I'd rather not say
How would you describe your sexual orientation?
Straight, homosexual, lesbian, bi-sexual, asexual etc.
What is your age?
Do you consider yourself to have a disability?
Please Select
Yes
No
I'd rather not say
Do you have a faith or religion?
How would you describe your ethnicity?
White British
Arab
Asian
White Other
Black
Mixed/Multiple Ethnic groups
I'd rather not say
Other
Do you care for anyone?
Yes, Child/children under 18
No, I don't have caring responsibilities
Yes, Child/children under the age of 5
Yes, I care for an elderly or disabled person
I'd rather not say
Submit
Should be Empty: