Clergy Training Feedback Form
1.
Please rate your level of agreement with the following statements:
Strongly Disagree
Somewhat Disagree
Neutral (Neither Agree nor Disagree)
Agree
Strongly Agree
I have increased confidence in my ability to respond appropriately if someone discloses abuse to me.
Strongly Disagree
Somewhat Disagree
Neutral (Neither Agree nor Disagree)
Agree
Strongly Agree
I know steps I should take if I suspect that someone is experiencing abuse.
Strongly Disagree
Somewhat Disagree
Neutral (Neither Agree nor Disagree)
Agree
Strongly Agree
I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors.
Strongly Disagree
Somewhat Disagree
Neutral (Neither Agree nor Disagree)
Agree
Strongly Agree
I understand my role as a member of the clergy in supporting survivors.
Strongly Disagree
Somewhat Disagree
Neutral (Neither Agree nor Disagree)
Agree
Strongly Agree
Other (please specify)
2.
Which actions do you plan to take following this workshop? (Select all that apply)
Share information about domestic abuse services.
Speak about domestic abuse from the pulpit, on my organization's website, or in programs.
Offer premarital counseling and support the use of prenuptial agreements where appropriate.
Refer to support services.
Other (please specify)
3.
I am interested in the following resources or workshops for my congregation/staff:
Dynamics of Domestic Abuse
Healthy Relationships
Teen Dating Violence Prevention
Security Procedures
Referral Protocols
Policies for handling domestic abuse situations
If you are interested in any resources or workshops, please provide your name:
4.
What additional information would you have liked to be provided during today's workshop?
5.
Additional Comments
6.
I would like a certificate of participation for today's workshop. If yes, please provide your name and email:
