SURVIVOR SCHOLARSHIP APPLICATION

SAFECHAIN™

SURVIVOR SCHOLARSHIP APPLICATION

Reorientation • Dignity • Empowerment

Thank you for your interest in applying for a SAFECHAIN™ Survivor Scholarship.

SAFECHAIN™ scholarships are funded through the Masquerade Ball Series and are awarded to women rebuilding after domestic abuse who wish to access structured reorientation, education, and empowerment training.

All information shared will be handled with discretion.

You are not required to disclose graphic or traumatic details.

SECTION 1 – PERSONAL DETAILS

Full Name:

Preferred Name (if different):

Email Address:

Phone Number (optional):

City/Town:

Country:

Are you currently in a safe living environment?

☐ Yes
☐ No
☐ Prefer not to say

(If urgent support is required, please contact local emergency services or domestic abuse helplines.)

SECTION 2 – ELIGIBILITY

SAFECHAIN™ scholarships are intended for women who:

• Have experienced domestic abuse
• Are rebuilding independently
• Require structured educational support
• Are seeking economic or professional reorientation

Do you confirm that you are applying based on lived experience of domestic abuse?

☐ Yes

SECTION 3 – CURRENT STAGE OF REBUILDING

Which best describes your current position? (Select all that apply)

☐ Recently left abusive relationship
☐ Ongoing legal proceedings
☐ Rebuilding financially
☐ Returning to work
☐ Managing childcare independently
☐ Experiencing isolation
☐ Seeking confidence rebuilding
☐ Seeking structured tools for stability

SECTION 4 – WHY YOU ARE APPLYING

In 300–500 words, please describe:

• What rebuilding currently looks like for you
• Why structured learning would support you
• What you hope to gain from the SAFECHAIN™ Survivor Pathway

(You do not need to share detailed trauma history.)

SECTION 5 – FINANCIAL CIRCUMSTANCES

Are you currently:

☐ Employed full-time
☐ Employed part-time
☐ Self-employed
☐ Unemployed
☐ On statutory leave
☐ Receiving benefits
☐ Prefer not to say

Do you confirm that paying full course fees would create financial hardship?

☐ Yes

SECTION 6 – COMMITMENT

Scholarships are awarded to applicants who demonstrate readiness to engage with structured learning.

If awarded a scholarship, I confirm that I will:

☐ Participate in the programme
☐ Complete modules within agreed timeframe
☐ Engage respectfully in any group components

SECTION 7 – CONFIDENTIALITY & CONSENT

SAFECHAIN™ will:

• Not publish your story without written consent
• Protect your identity
• Store information securely
• Use anonymised data for reporting if required

Do you consent to SAFECHAIN™ processing your information for scholarship review purposes?

☐ Yes

SECTION 8 – OPTIONAL

Would you be willing (entirely optional) to:

☐ Provide anonymous feedback after completing the course
☐ Share a testimonial (anonymous or named)
☐ Be contacted about future leadership opportunities

SECTION 9 – DECLARATION

I confirm that the information provided is true to the best of my knowledge.

Signature: _______________________
Date: ___________________________

SAFECHAIN™ INTERNAL REVIEW SECTION

Application ID: __________
Reviewed by: __________
Scholarship Awarded: Full / Partial / Declined
Notes: _______________________

"You are not required to justify your pain to access dignity. This application is about your future, not your past."