Application to embed Introductory Module: Any responder

Application and terms and conditions

This form is to apply for permission to access and use the embed codes for the Insight Exchange Introductory Module: Any Responder (video).
If you have questions that are not answered in the application form, please use the contact us page.
Thank you - The Insight Exchange Team

Question Title

* 1. I have permission from the organisation to make this application.

No (if no please obtain permission before proceeding)

Yes

Question Title

* 2. I understand and agree to the following terms:

In an effort to support social, service and systemic responses to domestic, family and sexualised violence, Insight Exchange is donating timebound access to the embed codes for the Insight Exchange Introductory Module - Any Responder (video) hosted on the Insight Exchange vimeo channel.

I understand that Insight Exchange materials cannot be used for commercial purposes or sold. Under no circumstances can a purchase or access fee be applied to Insight Exchange resources as these have been designed to be free for any and all readers/viewers to remove cost barriers.

I understand that due to copyright protection and version control local copies will not be provided as an alternative to embedding.

Disclaimer: Whilst great care has been taken to do no harm and to improve responses to people experiencing domestic, family and sexualised violence, Insight Exchange and the contributing organisations assume no responsibility for how the information in the resources is used.

Note: We recommend providing a short supportive introduction to the materials. Reflection resources for viewers are available on the Insight Exchange website and named in the module.

Yes I understand and agree to these terms

Question Title

* 3. Applicant Information (Complete all)

Full name

Role Title

Organisation

Contact Email

Specific Domain Name for embed permission

Question Title

* 4. We seek permission for access to the embed codes for this amount of time (tick one). After this date the embed access for your domain will be removed.

3months

6months

9months

12months

Question Title

* 5. How does your organisation plan to use the Module: Understanding and responding to strangulation? (Complete all that apply)

Induction: Employee
(please name sector/industry)

Ongoing professional development: Employee
(please name sector/industry)

Induction: Tertiary student
(please name tertiary course/school)

Ongoing Learning: tertiary student immersion/extension
(please name training/course)

Pre-requisite to training/course: Any participant
(please name training/course)

Question Title

* 6. I give consent for Insight Exchange to: (complete all)

	Yes	No
Name our organisation as a recipient of this donated resource	Name our organisation as a recipient of this donated resource Yes	Name our organisation as a recipient of this donated resource No
Contact our organisation to ask about the value of using the materials.	Contact our organisation to ask about the value of using the materials. Yes	Contact our organisation to ask about the value of using the materials. No
Include me (using the email address provided in this application) in Insight Exchange updates	Include me (using the email address provided in this application) in Insight Exchange updates Yes	Include me (using the email address provided in this application) in Insight Exchange updates No