Expression of Interest Application: Mid & West Wales Regional Survivor Advisory Panel

The Regional VAWDASV (Violence against Women, Domestic Abuse, and Sexual Violence) Partnership is establishing a Survivor Advisory panel for Mid and West Wales.

The purpose of the panel is to bring together survivors and survivor voices, with statutory and provider agencies through a raft of opportunities to inform and influence policy and practice in the region. As experts by lived experience of violence against women, domestic abuse and sexual violence, the panel will provide a mechanism to ensure the needs of survivors are at the heart of VAWDASV service planning and delivery in Mid & West Wales.

Your input will inform the future of VAWDASV Services in Mid & West Wales and we can’t do it without you.

THANK YOU SO MUCH FOR YOUR INTEREST IN THE PANEL.

* Before completing this survey please make sure you have read the Privacy Notice below and confirm that you are happy for your information to be collected and used in this way.

Data Protection Privacy notice
Some of the information collected in this application is personal data and considered to be special category or sensitive data under GDPR 2016 and Data Protection Act 2018.

Your personal information provided will be retained in a secure database. At no time will your personal data be published. We will retain the content provided by you in this application for recruitment purposes, and to monitor applicants and participant take up.

We will use your contact details to send you information relating to the Panel and to request feedback as part of the Panel activities. Except in connection with the activities described above or where required to do so by law, we will not disclose your data to any third parties without your permission. Carmarthenshire County Council take all reasonable precautions to prevent the loss, misuse or alteration of data.

The information provided by you will be stored and held for a period of up to 3 years. After this time the data will be deleted but the statistical results will be retained.

Data may be reported on collectively within reports and feedback shared with partner agencies and in wider communications. This will always be anonymised, but by providing it within this application you give your consent for it to be used.

If you have any questions about the application, how the data is collected or held, or to request a copy of your personal data please contact us at mww.survivor.panel@gmail.com

1. Are you happy for your information to be collected in this way? *

Yes
No

2. Name and Contact Details *

Name & Address	*
Email address	*
Telephone number	*

3. In which Local Authority area do you live?

Carmarthenshire
Ceredigion
Pembrokeshire
Powys

4. Have you ever been affected by any of the following?

5. How do you want to get involved in the panel?

Written response
Attending regular panel meetings every 2-3 months
Taking part in focus groups/consultation events
Taking part in surveys
Providing written input/feedback
Feeding back on a 1 to 1 basis
Other (please specify):

6. How do you want us to communicate with you?

7. Please tell us why you would like to get involved in the Survivor Advisory Panel for Mid & West Wales?

8. Do you need any support to get involved in any way with this panel? If so, please tell us what support you would need so we can look to help with this and discuss this with you further?