Survivor Form

Contact Details

Please provide contact details for your application.

Name(Required)

First Last

Email(Required)

Phone Number(Required)

e.g. 07XX YYYY YYY

Date of birth(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred contact time

Morning

Afternoon

Anytime

Other

Additional Information

Please provide the following additional information to help us place your application.

Gender(Required)

Ethnicity(Required)

Faith

Number of dependents(Required)

What is your employment status?

Application details

Please provide the following information as part of your application.

How did you hear about Karma Nirvana?(Required)

Have you ever accessed the Karma Nirvana's helpline?(Required)

Please provide an overview of your personal experiences which have encouraged you to apply(Required)

What are your expectations from the role?(Required)

How much time do you think you are able to commit to the role?(Required)

Are there, or do you foresee any risks in joining the Karma Nirvana survivor ambassador panel?(Required)

This will not necessarily exclude your application, but the management team will need to consider this to manage risk/safety. Please include any areas in the UK which may be a risk to you.

Would you prefer to share your identity or remain anonymous?(Required)

Do you have any travelling restrictions?(Required)

Do you have any health conditions we should be aware of?(Required)

Is there any part of the role you do not feel comfortable with?(Required)

What would you like to see changed in the field of honour based abuse?(Required)

Please note: if you wish to work in schools this will require a DBS check to be carried out by Karma Nirvana. Please let us know if there is anything that may affect this

Name

This field is for validation purposes and should be left unchanged.

Survivor Ambassador Panel Application Form

Contact Details

Additional Information

Application details