Independent Sexual Violence Advisers Grant Application Form 2011/12 – 2014/15 Please put an X in one of the boxes below to show which type of ISVA the application is for: Voluntary and community sector Sexual assault referral centre 1. Name and contact details of organisation submitting the application: 2. Name and contact details of Community Safety Partnership, local authority or other partnership endorsing the application: 3. Please provide details of the experience held by the applicant organisation in delivering services for victims of sexual violence: 1 4. Please provide a summary of data on sexual violence in your area and the sources from which it is taken. 5. What formal and informal protocols do you have in place for working with the police, local Sexual Assault Referral Centre/Voluntary and Community Sector, and other local partners? Please provide details of agreed referral pathways. 2 6. Is this funding for a new or existing ISVA post? 7. Where will the ISVA be based? 8. What will the ISVA expected working pattern and likely caseload be? 9. Are there any restrictions on the client groups that the ISVA will work with e.g. would the ISVA be focused only on adult women or also on girls, children or men? If there is a restriction, what is it and what support or signposting will you offer such clients if they present to you? 10. ISVAs can work with distressing cases and in distressing circumstances. It is essential they are supported to do this with regard to their own health and welfare. Please set out how the ISVA will be managed, including clinical management, to ensure the ISVA is supported, is providing an appropriate and safe service to clients and is observing appropriate protocols. 3 11. How will you fully fund the cost of the ISVA service in 2011/12 and beyond to 2014/15? Do you expect to be able to mainstream this service beyond that point and what steps will take to ensure this happens? 12. In some circumstances, the Home Office is able to provide funding to voluntary organisations in advance of expenditure. If you would like to be considered for this payment arrangement, please outline your case below. Any decisions will be taken in partnership with the Home Office Finance Team. 13. What training will be provided for the ISVA? Please return this application form by 4th February 2011 to: sexualviolence@homeoffice.gsi.gov.uk 4