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* 1. DURING YOUR RELATIONSHIP (i.e before separation)
Domestic Violence takes many forms .. (tick every box that applied during your marriage/relationship - any violence occurring after separation is covered in a later question).

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* 2. When you physically separated from your ex partner, did the situation

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* 3. CHILD ABUSE
If any of the below violence occurred by your children's father/step father, please tick all boxes according to when they actually occurred?

  Before Separation After Separation During Court process After Final Court Orders
Mother - direct threat to be killed or harmed
Child - direct threat to be killed or harmed
Evidence/signs of child physical abuse
Child disclosed sexual assault/grooming
Child refuses to attend contact (crying at, prior to or after contact)
Evidence/signs of mental/emotional abuse (alienation, denigrating mother, threaten harm, lies, harm to animals)
Child PTSD (wetting bed, acting out, refusing to attend school, clingy, fear/anger of father at father, )

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* 4. STATE VIOLENCE PROTECTION ORDERS
Please tick the boxes below that fit your situation?

  Before Separation After Separation During Court process After Final Court Orders
Police involvement/records
Violence Protection Order/s was in place
Violence Protection Order/s Breached by him
Applied for Protection Order, but failed
Violence Protection Order never applied for

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* 5. When you referred to your experiences of domestic violence and/or child abuse allegations inside the family court arena, which judicial officer/s did you feel trivialised or ignored it in any way?

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* 6. FAMILY COURT ORDERS...
Were you pressured in any way to agree to your family court orders (including interim, consent or final orders), that did not (partly or fully) take into account your Domestic Violence and child abuse situation?

e.g. told you may lose your children, lose your funding or representation, that you will be labelled as "unfriendly parent" if you don't agree, or your concerns simply ignored .. etc?

Please "quote" ... what you were told?

[start a fresh line for each different "quote" ... and begin the quote with which officer said it to you (e.g. my lawyer; my barrister; Judge etc)]

P L E A S E DO NOT add any details other than the words said to you by the judicial officer/s. (more space is available)

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* 7. LEGAL AID FUNDING...
If you were granted or applied for a Legal Aid at any point, please "quote" below (what was said to you) if you experienced any pressure or threats of losing your Legal Aid Grant .. relating to minimising/ignoring your domestic violence or child abuse allegations?

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* 8. ALL OTHER JUDICIAL OFFICERS
Please "quote" below exactly (to the best of your memory, if not recorded), what was said to you when you felt your domestic violence or child abuse allegations were being minimised/ignored .. or you were pressured to let some or all of your DV experiences go?

[start a fresh line for each different "quote" ... and begin the quote with which officer said it to you (e.g. my lawyer; my barrister; court expert witness; Judge etc)]

P L E A S E DO NOT add any details other than the words said to you by the judicial officer/s. (more space is available)

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* 9. EXTRA SPACE FOR "QUOTES"
If you have run out of room to write your quotes in Question 4 or 5, use this space below.

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* 10. Please tick the appropriate boxes in each column to indicate how yours and your child's experience of domestic violence at these 4 stages has changed?

(Note: your answers in column 1 "Before Separation" should be the same as your answers in Question 1 of this survey).

  Before Separation After Separation During Court process After Final Court Orders
a. Physical Abuse
b. Sexual Abuse
c. Emot/Psych Abuse
d. Verbal Abuse
e. Financial Abuse
f. Child abuse
g. Child sexual abuse
h. Isolation/social Abuse
I. Stalking/Cyber Abuse
N/A

T