Clergy Training Feedback Form Survey

	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.	I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Strongly Disagree	I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Somewhat Disagree	I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Neutral (Neither Agree nor Disagree)	I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Agree	I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Strongly Agree
I know steps I should take if I suspect that someone is experiencing abuse.	I know steps I should take if I suspect that someone is experiencing abuse. Strongly Disagree	I know steps I should take if I suspect that someone is experiencing abuse. Somewhat Disagree	I know steps I should take if I suspect that someone is experiencing abuse. Neutral (Neither Agree nor Disagree)	I know steps I should take if I suspect that someone is experiencing abuse. Agree	I know steps I should take if I suspect that someone is experiencing abuse. 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.	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	I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. Somewhat Disagree	I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. Neutral (Neither Agree nor Disagree)	I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. 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 Agree
I understand my role as a member of the clergy in supporting survivors.	I understand my role as a member of the clergy in supporting survivors. Strongly Disagree	I understand my role as a member of the clergy in supporting survivors. Somewhat Disagree	I understand my role as a member of the clergy in supporting survivors. Neutral (Neither Agree nor Disagree)	I understand my role as a member of the clergy in supporting survivors. Agree	I understand my role as a member of the clergy in supporting survivors. Strongly Agree

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.

I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Strongly Disagree

I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Somewhat Disagree

I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Neutral (Neither Agree nor Disagree)

I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Agree

I have increased confidence in my ability to respond appropriately if someone discloses abuse to me. Strongly Agree

I know steps I should take if I suspect that someone is experiencing abuse.

I know steps I should take if I suspect that someone is experiencing abuse. Strongly Disagree

I know steps I should take if I suspect that someone is experiencing abuse. Somewhat Disagree

I know steps I should take if I suspect that someone is experiencing abuse. Neutral (Neither Agree nor Disagree)

I know steps I should take if I suspect that someone is experiencing abuse. Agree

I know steps I should take if I suspect that someone is experiencing abuse. 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.

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

I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. Somewhat Disagree

I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. Neutral (Neither Agree nor Disagree)

I am aware of the steps I can take to reduce the stigma around domestic abuse and create a welcoming space for survivors. 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 Agree

I understand my role as a member of the clergy in supporting survivors.

I understand my role as a member of the clergy in supporting survivors. Strongly Disagree

I understand my role as a member of the clergy in supporting survivors. Somewhat Disagree

I understand my role as a member of the clergy in supporting survivors. Neutral (Neither Agree nor Disagree)

I understand my role as a member of the clergy in supporting survivors. Agree

I understand my role as a member of the clergy in supporting survivors. Strongly Agree

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* 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)

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* 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:

Clergy Training Feedback Form

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* 1. Please rate your level of agreement with the following statements:

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* 2. Which actions do you plan to take following this workshop? (Select all that apply)

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* 3. I am interested in the following resources or workshops for my congregation/staff:

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* 4. What additional information would you have liked to be provided during today's workshop?

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* 5. Additional Comments

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* 6. I would like a certificate of participation for today's workshop. If yes, please provide your name and email: