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EU PARTNER AGENCY APPLICATION_SEPTEMBER 2023
All agencies that wish to become a Safe & Together Model Partner Agency and support a Certified Trainer are required to submit this application form for consideration. A Partner Agency fee of £440.00GBP applies to all new Partner Agency applications that are accepted.
You may wish to write your responses in a Word document and then transfer them to this application form so all of your changes are saved in a separate place.
Partner Agency
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Agency Contact Name
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First
Last
Position or Role of Agency Contact
*
Agency Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo - Brazzaville
Congo - Kinshasa
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
Hong Kong SAR China
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR China
Republic of North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé & Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
St. Barthélemy
St. Helena
St. Kitts & Nevis
St. Lucia
St. Martin
St. Pierre & Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
U.S. Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Contact Phone Number
Contact Email
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How many Certified Trainers do you expect to submit for upcoming training? (You may select up to 5 individuals.)
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Enter a value between
0
and
5
.
Please list the names of the staff from your agency who plan to apply.
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Type of Agency
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NGO
Government
Educational Institution
Other
Maximum of
250
characters.
Currently Used:
0
characters.
Are you a registered Charity?
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YES
NO
If you are a registered Charity, please provide your VAT number.
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Primary Nature of Your Agency's Work
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Child and Family Services
Child Safety
Family Violence
Other
Maximum of
250
characters.
Currently Used:
0
characters.
Select the choice that applies best.
Briefly describe your agency's mission.
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Briefly describe your agency's services or work related to family violence.
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Briefly describe your agency's services or work related to child protection.
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Briefly describe your agency's involvement with the Safe & Together Institute (or its predecessor agency David Mandel & Associates, LLC).
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Please describe why you want to host a Safe & Together Model Certified Trainer. How is it relevant to your agency's mission? What do you hope to accomplish by hosting a Certified Trainer?
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How does the Trainer Certification Program support your plan for wider system change to become more domestic violence informed?
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What stage are you in developing a plan for wider system change?
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We just started thinking about it.
We have a draft of a plan.
We have a developed plan but haven't started implementing.
We have a developed plan that we are implementing.
Successful Partner Agencies usually develop a plan for supporting Certified Trainers to use work time to complete assignments for the Certification Process and helping manage their workload especially when the Certified Trainer has other significant responsibilities. Please describe your agency's commitment and plan to:
1. Manage and supervise the Certified Trainer;
2. Support the Certified Trainer throug the 14 month trainng program which includes required assignments, preparing for and delivering training, and 12 monthly 90 minute mentoring calls;
3. Support your Certified Trainer in conducting trainings as part of their role within your agency.
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TECHNOLOGICAL NEEDS FOR CERTIFIED TRAINERS
A Certified Trainer will need to access their training materials electronically, be able to attend the monthly Mentor Video Calls, and upload their training videos for review and feedback. These critical elements of the Trainer Certification Program all require access to certain technological platforms, including Google drive, Dropbox, Surveymonkey, and Zoom for videoconferencing.
Do you see any barriers to your Certified Trainers accessing this technology?
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No. Great!
Yes (If yes, we can work with your tech support to ensure access to these platforms.)
AS A COMPONENT OF THIS PARTNER AGENCY APPLICATION, IT IS MANDATORY THAT THE TRAINER CERTIFICATION PROGRAM INFORMATIONAL SESSION BE VIEWED BY AN AGENCY REPRESENTATIVE. THIS INFORMATIONAL SESSION WILL REVIEW SERVICE AGREEMENT DETAILS, PARTNER AGENCY, TRAINER AND SAFE & TOGETHER RESPONSIBILITIES. ALL TRAINER CANDIDATES ARE ENCOURAGED TO VIEW AS WELL.
PLEASE VIEW THE RECORDED INFORMATIONAL SESSION VIA THIS LINK:
INFO SESSION
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I have read and understand that an agency representative must view the recorded informational session.
UPON ACCEPTANCE, PARTNER AGENCIES AND TRAINERS ARE REQUIRED TO SIGN A SERVICE AGREEMENT. WE INVITE YOU TO PLEASE REVIEW THE SERVICE AGREEMENT TEMPLATE IN ADVANCE BY USING THIS LINK:
SERVICE AGREEMENT
THE FINAL AGREEMENT WILL BE DRAFTED AND SENT UPON YOUR TRAINERS' COMPLETION OF THE 12 WEEK TRAIN THE TRAINER.
PLEASE INDICATE THAT YOU HAVE REVIEWED AND UNDERSTAND THE FORTHCOMING SIGNATURE REQUIREMENTS FOR THE SERVICE AGREEMENTS.
*
I have reviewed and understand the forthcoming signature requirements for the Service Agreements.
PLEASE INDICATE YOU HAVE READ AND AGREE TO THE FOLLOWING:
RIGHTS AND RESPONSIBILITIES OF CERTIFIED TRAINERS AND THEIR AGENCIES
The Safe & Together Institute expects the agencies and individuals it partners with to commit to the following:
● To actively work toward faithful implementation of the Safe & Together Model
● To actively collaborate with the Safe & Together Institute (US) to achieve this goal
● To use only Safe & Together Model material and/or other material approved by the Safe & Together Institute in its Safe & Together Model trainings
● To sign intellectual property agreements related to the Safe & Together Model material
● To use the Safe & Together Institute online registration and payment system for all Safe & Together Model trainings including trainings provided internally within agencies
● To participate in all relevant Safe & Together Model training and services evaluation efforts
● To participate and support all Safe & Together Model certification and testing protocols
● To provide quarterly reports on all trainings including but not limited to: 4 day CORE Practice Training, 1 day Overviews, and 1-hour briefings performed by Safe & Together Model Certified Trainers
INTELLECTUAL PROPERTY
The Safe & Together Institute retains all intellectual property rights to Safe & Together Model material.
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I have read and agree to the Rights and Responsibilities outlined above.
Date of Agreement
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MM
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