Dd Form 2950 – Fill Out and Use This PDF

Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)

APPLICATION PACKET FOR NEW APPLICANTS

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 1561, note, Sexual Assault Response Coordinators and Sexual Assault Victim Advocates; 10 U.S.C. 136; DoD Directive 6495.01; DoD Instruction 6495.02; and DTM 14-001.

PRINCIPAL PURPOSE(S): The information provided on this form will be used to review and process applications for Sexual Assault Response Coordinator (SARC) and Sexual Assault Prevention and Response Victim Advocate (SAPR VA) certification.

ROUTINE USE(S): The DoD "Blanket Routine Uses" found at:

http://dpcld.defense.gov/privacy/SORNsIndex/BlanketRoutineUses.aspx apply.

DISCLOSURE: Voluntary. However, if you are a SARC or SAPR VA and do not complete this form to become certified, you may be disqualified from the position. 10 U.S.C. 1561, note requires DoD to establish a certification program.

APPLICATION INSTRUCTIONS

All Sexual Assault Response Coordinators (SARC) and Sexual Assault Prevention and Response Victim Advocates (SAPR VA) must be Military or Department of Defense (DoD civilian employees and must hold this DoD Sexual Assault Advocate Certification Program (D-SAACP) Certification to perform SARC or SAPR VA duties. There are four (4) Certification levels for D-SAACP. Please review the Application Worksheet (below) to determine the Level for which you qualify and which documents you must complete. Provide all required information and completed forms. (Photocopies of training documentation/certificates are acceptable.) Application deadlines: 31 October, 31 January, 30 April, and 31 July.

If you are currently certified through D-SAACP and are renewing your certification, do not complete this form. Please use DD Form 2950-1, the Renewal Application.

APPLICATION WORKSHEET

Determine the position for which you are applying (if you are unsure, please confirm with your SAPR Program Manager):

I am applying for certification as a SARC/SAPR PM.

I am applying for certification as a SAPR VA.

All Applicants must submit:

Signed Application. All information must be completed and application must be signed and dated (hand or digital).

Signed SAPR Professional Code of Ethics (pages 4-5).

Supervisor and Commander Statement of Understanding (page 10).

Two Letters of Recommendation.

I am applying for certification as a SARC/SAPR PM. The following two Letters of Recommendation are required (see exception below):

-A signed Letter of Recommendation from a Supervisor (page 12). The signing supervisor must be, at minimum, an O3, E7, CW2, or GS-9 in each respective pay grade. The signing supervisor must be in my chain of command.

-A signed Letter of Recommendation from my Commanding Officer (page 13). The signing Commanding Officer must be, at minimum, an O6 or GS-15 and in my chain of command.

Exception: The first person in my chain of command and my Commanding Officer are the same person. I need to submit only one Letter of Recommendation. (Exception applicable only to SARCs/SAPR PMs.)

I am applying for certification as a SAPR VA. The following two Letters of Recommendation are required:

-A signed Letter of Recommendation from my supervising SARC (page 11).

-A signed Letter of Recommendation from my Supervisor (page 12). The signing supervisor must be, at minimum, an O3, E7,CW2, or GS-9 in each respective pay grade and in my chain of command.

Note: The Commanding Officer and/or Supervisor signing your Recommendation must affirm that requirements were met for assignment eligibility screening per DoDI 6495.03, Section 2.

Training Documentation.

I have completed the requisite National Advocate Certification Program (NACP) pre-approved training course(s). I am submitting a certificate of course completion. (See www.trynova.org for approved courses.) Certificate must reflect name, location, dates and numbers of hours for the training course and signature of official Service/NGB trainer.

DD FORM 2950, JAN 2020

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 13 Pages

Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)

APPLICATION PACKET FOR NEW APPLICANTS

APPLICATION WORKSHEET (Continued)

Calculate Hours of Sexual Assault Advocacy Experience

In addition to DoD experience, you may count civilian or non-DoD experience towards your total hours, given that the experience was providing sexual assault victim advocacy services.

For full-time advocacy experience: Take the number of hours each week worked as a sexual assault victim advocate and multiply by 52 (weeks in a year) to calculate hours per year. Multiply that number by number of years served as a full time sexual assault victim advocate. If you served for less than one year, multiply by the number of weeks you served as a full-time sexual assault victim advocate. No more than 40 hours per week will be accepted.

Example: (40 hours per week) x (52 weeks) = 2,080 hours. (2,080 hours) x (5 years) = 10,400 hours.

For part-time advocacy experience: Take the number of hours providing sexual assault victim advocacy each week and multiply by 52 (weeks in a year) to calculate hours per year. Multiply that number by number of years served as part-time SARC/SAPR VA. If you served for less than one year, multiply by the number of weeks you served as a part-time SARC or SAPR VA by the number of hours per week.

Example: (8 hours per week) x (52 weeks) = 416 hours. (416 hours) x (2 years) = 832 hours. - or -

For part-time "on-call" advocacy experience: Take the number of times on call per year and multiply by average number of hours providing sexual assault victim advocacy per shift. Multiply that number by number of years served as a part-time SARC/SAPR VA. Example: (30 times on call in a year) x (5 average number of hours providing victim advocacy per shift) = 150 hours.

(150 hours) x (3 years) = 450 hours.

Determine the Level for which you should apply:

I have between 0 and 3,900 hours experience providing sexual assault victim advocacy services.

Apply as a Level I.

I have between 3,900 and 7,800 hours experience providing sexual assault victim advocacy services. I have also provided sexual assault victim advocacy services on three or more occasions in the past two years. Apply as a Level II.

I have between 7,800 and 15,600 hours experience providing sexual assault victim advocacy services. I have also provided sexual assault victim advocacy services on three or more occasions in the past two years. Apply as a Level III.

I have more than 15,600 hours experience providing sexual assault victim advocacy services. I have also provided sexual assault victim advocacy services on three or more occasions in the past two years. Apply as a Level IV.

I have more than 3,900 hours experience providing sexual assault victim advocacy services, but have not provided sexual

assault victim advocacy services on three or more occasions in the past two years. Apply as a Level I.

Verify and Evaluate Experience for Levels II, III, or IV.

Note: In addition to verifying hours of sexual assault victim advocacy experience, applicants must also have provided victim advocacy services in the past two years on three or more occasions, to one or more victims. See Verification of Sexual Assault Victim Advocacy Experience (pages 6 - 7) for further details.

I am applying at Level I. Therefore, I do not need to submit Verification or Evaluations of Sexual Assault Victim Advocacy Experience.

I am applying for Level II, III or IV. I must submit Verification(s) of Sexual Assault Victim Advocacy Experience (pages 6 -

7)and Evaluation(s) of Sexual Assault Victim Advocacy Experience (pages 8 - 9).

Evaluation(s) of Sexual Assault Victim Advocacy Experience (pages 8 - 9). Submit completed Evaluation(s) of Sexual

Assault Victim Advocacy Experience signed and dated by your supervisor(s) after determining the appropriate Level to which you should apply.

	Instructions for submittal can be found at www.sapr.mil.
DD FORM 2950, JAN 2020	Page 2 of 13 Pages

Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)

NEW APPLICATION

SAPR PROFESSIONAL CODE OF ETHICS

Every Sexual Assault Response Coordinator (SARC) and Sexual Assault Prevention and Response Victim Advocate (SAPR VA) must act with integrity, treat all victims of sexual assault crimes with dignity and compassion, and uphold principles of justice for accused and accuser alike.

To these ends, this Code will govern the conduct of SARC/SAPR VAs:

I.In relationships with every victim, the SARC/SAPR VA shall:

1.Recognize the interests of the victim as a primary responsibility.

2.Respect the victim's civil and legal rights, subject only to laws requiring disclosure of information to appropriate other sources.

3.Respect the victim's rights to privacy and confidentiality, subject only to laws requiring disclosure.

4.Respond compassionately to each victim with personalized services.

5.Accept the victim's statement of events as it is told, withholding opinion or judgment, whether or not a suspected offender has been identified, arrested, convicted, or acquitted.

6.Provide services to every victim, within policy guidelines set by the DoD and the Services, without attributing blame, no matter what the victim's conduct was at the time of the victimization or at another stage of the victim's life.

7.Foster maximum self-determination on the part of the victim.

8.Serve as a victim advocate when assigned, and in that capacity, act on behalf of the victim's stated needs and within policy guidelines set by DoD and the Services.

9.Should one victim's needs conflict with another's, act with regard to one victim only after promptly referring the other to another qualified SARC/SAPR VA.

10.Have no personal or sexual relations with victims currently supported by SARCs or SAPR VAs or with alleged offenders, in recognition that to do so risks exploitation of the knowledge and trust derived from the professional relationship.

11.Make victim referrals to other resources or services only in the victim's best interest, avoiding any conflict of interest in the process, and do so in accordance with DoD regulations.

II.In relationships with colleagues, other professionals, and the public, the SARC/SAPR VA shall:

1.Conduct relationships with colleagues in such a way as to promote mutual respect and improvement of service.

2.Conduct relationships with allied professionals such that they are given equal respect and dignity as professionals in the victim assistance field.

3.Take steps to quell negative, insubstantial rumors about colleagues and allied professionals.

DD FORM 2950, JAN 2020

Page 4 of 13 Pages

Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)

NEW APPLICATION

SAPR PROFESSIONAL CODE OF ETHICS (Continued)

II.(Continued)

4.Share knowledge and encourage proficiency and excellence in victim assistance among colleagues and allied professionals, paid and volunteer.

5.Provide professional support, guidance, and assistance to new SARCs/SAPR VAs to the field in order to promote consistent quality and professionalism in victim assistance.

6.Obey all applicable Federal, DoD, and Service laws and regulations.

III.In her or his professional conduct, the SARC/SAPR VA shall:

1.Maintain high personal and professional standards in the capacity of a service provider and advocate for victims.

2.Seek and maintain a proficiency in the delivery of services to victims.

3.Not discriminate against any victim, employee, colleague, allied professional, or member of the public on the basis of age, gender, disability, ethnicity, race, national origin, religious belief, or sexual orientation.

4.In accordance with restricted reporting, applicable privileged communications, and all applicable Federal, DoD, and Service privacy laws and regulations, respect the privacy of information provided by the victims served before, during, and after the course of the professional relationship.

5.Clearly distinguish in public statements representing one's personal views from positions adopted by organizations for which she or he works or is a member, in accordance with Service policy.

6.Not use her or his official position to secure gifts, monetary rewards, or special privileges or advantages.

7.Notify competent authorities of the conduct of any colleague or allied professional that constitutes mistreatment of a victim or that brings the profession into disrepute.

8.Notify competent authorities of any conflict of interest that prevents oneself or a colleague from being able to provide competent services to a victim, or from working cooperatively with colleagues or allied professionals, or from being impartial in the assistance of any victim.

9.Notify competent authority immediately if charged, arrested, and/or convicted of any criminal activity.

IV. In her or his responsibility to any other profession, the SARC/SAPR VA will be bound by the ethical standards of the allied profession of which she or he is a member.

CERTIFICATION: I, the undersigned applicant, hereby certify that I have read and agree to follow the Code of Professional Ethics for a SARC/SAPR VA. I understand that this Certification is subject to surrender on demand to my SAPR Program Manager for cause, and this action may be listed in my permanent record by my Senior Commander.

Print Applicant Name (Last, First, Middle Initial):

Signature of Applicant:		Date Signed
		(YYYYMMDD):
DD FORM 2950, JAN 2020			Page 5 of 13 Pages

Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)

NEW APPLICATION

VERIFICATION OF SEXUAL ASSAULT VICTIM ADVOCACY EXPERIENCE

provided direct service to those victimized by sexual assault

(Name of applicant)

at

in the capacity of

(Name of installation/command/agency)

(Position title - SARC, SAPR VA or other)

from

to

and worked

hours per week during this time.

(YYYYMMDD)

(YYYYMMDD)

The position was (X):

full time

part time. (If position was held as a collateral duty, please mark as part time.)

CONFIRMATION

I confirm the information on this Verification of Sexual Assault Victim Advocacy Experience is accurate to the best of my knowledge.

a. NAME	b. TITLE/POSITION	c. OFFICE/TELEPHONE NUMBER
d. SIGNATURE		e. DATE (YYYYMMDD)
DD FORM 2950, JAN 2020		Page 7 of 13 Pages

Use additional copies of this page for each position held by this Applicant.