DD Form 2950-1 "Sexual Assault Advocate Certification Program (D-Saacp) - Renewal Applicantion Packet"

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This is a form that was released by the U.S. Department of Defense (DoD) on March 1, 2015. The form, often mistakenly referred to as the DA Form 2950-1, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

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Download DD Form 2950-1 "Sexual Assault Advocate Certification Program (D-Saacp) - Renewal Applicantion Packet"

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Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
RENEWAL APPLICATION PACKET
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 (SAPR) Victim Advocate (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 (SAPR) Victim Advocates (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.
This Application Form, DD Form 2950-1, is for Renewal Applicants ONLY. If you are applying for the first time to D-SAACP,
do not complete this form. Please use DD Form 2950, the Application Packet for New Applicants.
APPLICATION INSTRUCTIONS/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.
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 D-SAACP 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. 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, CWO2, 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.)
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, CWO2, or GS-9 in each respective pay grade and in my chain of command.
Note: The Commanding Officer and/or Supervisor signing your Letter(s) of Recommendation must confirm on that Letter that the
required background screening has been completed. Do not send a copy of the background investigation with your completed
application.
Training Documentation for 32 Hours of Continuing Education.
I am renewing my D-SAACP certification and have completed the 32 requisite hours of continuing education training
courses. I am submitting Documentation of Continuing Education Training Courses (see Pages 14 - 15 for more details).
DD FORM 2950-1, MAR 2015
Page 1 of 15 Pages
Adobe Designer 9.0
Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
RENEWAL APPLICATION PACKET
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 (SAPR) Victim Advocate (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 (SAPR) Victim Advocates (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.
This Application Form, DD Form 2950-1, is for Renewal Applicants ONLY. If you are applying for the first time to D-SAACP,
do not complete this form. Please use DD Form 2950, the Application Packet for New Applicants.
APPLICATION INSTRUCTIONS/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.
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 D-SAACP 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. 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, CWO2, 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.)
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, CWO2, or GS-9 in each respective pay grade and in my chain of command.
Note: The Commanding Officer and/or Supervisor signing your Letter(s) of Recommendation must confirm on that Letter that the
required background screening has been completed. Do not send a copy of the background investigation with your completed
application.
Training Documentation for 32 Hours of Continuing Education.
I am renewing my D-SAACP certification and have completed the 32 requisite hours of continuing education training
courses. I am submitting Documentation of Continuing Education Training Courses (see Pages 14 - 15 for more details).
DD FORM 2950-1, MAR 2015
Page 1 of 15 Pages
Adobe Designer 9.0
Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
RENEWAL APPLICATION PACKET
APPLICATION INSTRUCTIONS/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.
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 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 to which you should apply:
I have between 0 and 3,900 hours experience providing sexual assault victim advocacy services.
Apply for renewal at 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 for renewal at 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 for renewal at 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 for renewal at 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 for renewal at 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 already certified at Level I, but do not have enough time and/or the required Sexual Assault Victim Advocacy Experience
for a higher level. I do not need to verify my sexual assault victim advocacy experience. I am not submitting Verification or
Evaluations of additional Sexual Assault Victim Advocacy Experience. I am re-applying for renewal at Level I.
I am re-applying for renewal at my level of Level II, III, or IV. I do not need to verify my sexual assault victim advocacy
experience.
I am applying for renewal and advancement to the next level in certification. 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 2950-1, MAR 2015
Page 2 of 15 Pages
FOR CREDENTIALING BODY USE ONLY:
Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
Application ID Number
RENEWAL APPLICATION
1. APPLICANT NAME
a. LAST NAME
b. FIRST NAME
c. MIDDLE INITIAL
2. SERVING IN THE POSITION OF: (X one)
Sexual Assault Response Coordinator (SARC)
Sexual Assault Prevention and Response Victim Advocate (SAPR VA)
3. AFFILIATION (X one)
AIR FORCE
ARMY
MARINE CORPS
NAVY
DoD AGENCY
4. STATUS (X as applicable)
ACTIVE DUTY
RESERVIST
ACTIVE DUTY RESERVIST
NATIONAL GUARD
CIVILIAN
5a. RANK
5b. GRADE
6a. COMMAND (UNIT)
6b. INSTALLATION
7. WORK TELEPHONE NUMBER (Include area code/DSN/extensions)
8. WORK EMAIL ADDRESS (.mil or .gov email addresses only)
I do not have a .mil or .gov email address at this time. Please use
my SARC or Supervisor's email address, which is given above.
PLEASE SEND TO MY SARC'S OFFICIAL MILITARY
8.a.
PLEASE SEND TO MY OFFICIAL MILITARY ADDRESS:
8.b.
ADDRESS:
Commanding Officer
Commanding Officer
(Command or Unit)
(Command or Unit)
ATTN:
ATTN:
(Rank and Name of Applicant)
(Rank and Name of SARC)
(Address of Command*)
(Address of Command*)
(Installation, City, FPO, or APO)
(State)
(ZIP Code)
(Installation, City, FPO, or APO)
(State)
(ZIP Code)
*Remember to include building or suite number if required in the official
*Remember to include building or suite number if required in the official
address.
address.
It is the responsibility of the applicant to ensure that the credentialing body has the most current contact
information at all times. For instructions on updating your contact information, please visit www.sapr.mil.
9. The D-SAACP level for which I am applying is: (X one) (See Application Worksheet on Page 1 for eligibility and required attachments.)
Level I
Level II
Level III
Level IV
10. TYPE OF CERTIFICATION APPLICATION (X one)
10a. CURRENT D-SAACP CERTIFICATION NUMBER
RENEWAL AT SAME LEVEL
RENEWAL AT HIGHER LEVEL
11. APPLICANT CERTIFICATION.
I, the undersigned Applicant, hereby certify the information submitted on this application is true and accurate. I further certify the
information reported on any enclosures is true and accurate. I further certify that I completed this application myself.
a. SIGNATURE OF APPLICANT
b. DATE SIGNED (YYYYMMDD)
DD FORM 2950-1, MAR 2015
Page 3 of 15 Pages
Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
RENEWAL APPLICATION
SARC/SAPR VA CODE OF PROFESSIONAL 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 2950-1, MAR 2015
Page 4 of 15 Pages
Department of Defense Sexual Assault Advocate Certification Program (D-SAACP)
RENEWAL APPLICATION
SARC/SAPR VA CODE OF PROFESSIONAL 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 authorities 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)
Date Signed
Signature of Applicant:
:
(YYYYMMDD)
DD FORM 2950-1, MAR 2015
Page 5 of 15 Pages