Submit your pledge

Please complete the below online form to submit your organisation's pledge to end domestic and family violence (DFV) in your workplace.

Privacy

We are collecting your information for the purpose of processing your pledge for the Not now, not ever. Together. initiative, including publishing your company logo, website link, story, associated photos and/or videos and contact details.

Submissions that do not align with our initiative may not be published. All submissions must be suitable for viewing by people of all ages. All submissions will be moderated for suitable content before being published online.

We will handle your personal information in accordance with the Information Privacy Act 2009.

Note: You are required to consent to the Queensland Government publishing and sharing the information you provide. If you are not happy for this to occur, please do not complete this form.

1. Organisation contact details

   1. Organisation name
   2. First name *
   3. Surname *
   4. Position title *
   5. Email (work) *
   6. Phone (work) *
   7. Organisation's website URL *

   Organisation address

   1. Street address *
   2. Suburb/town *
   3. State *

      -- Please Select --ACTNSWNTQLDSATASVICWA
   4. Postcode *
2. Commitment to action

   Taking the pledge is a demonstration of your organisation’s commitment to prevent DFV.

   As part of your commitment, please provide your organisation logo and a brief description of the action/s you are committing to taking.

   1. Organisation logo. * Please upload a full-colour version of your logo with a transparent background in JPG or PNG format sized 100 x 100 pixels. Logos provided that do not meet these specifications cannot be published and will need to be re-supplied.
   2. Description of the action/s you are committing to taking. * Please limit to 250 words.
3. Share your story

   Sharing your success story on this website helps other organisations see what their colleagues are doing, gives them a range of ideas, and helps to build our community.

   If you have a success story displaying your organisation's commitment to ending DFV, please provide the following:

   • Name of your story or initiative.
   • Describe the story you are sharing, as you would like it to appear on the website. A good way to do this is to answer the questions: who, what, when, where and why. Please include a timeframe for when it happened.
   • Which region does your story apply to?
   • Up to 2 photos sized 700 x 350 pixels landscape in JPG format.

   If available you can also provide:

   • A YouTube video URL about your story hosted on your organisation’s channel.
   • The website URL where more information can be found about your story.
   • Contact details for more information, which will be published on this site alongside your story.

   1. Would you like to share your story? *

      -- Please Select --YesNo
4. Story details

   1. Name of your story
   2. Description Please limit to 250 words.
   3. Which region does your story apply to?

      • Northern Queensland
      • Central Queensland
      • Moreton
      • South East
      • South West
   4. Which category does your story apply to Choose 1 only

      -- Please Select --CommunitySchoolWorkplaceSporting club
   5. Attach photo/s * Maximum 2
   6. YouTube URL
   7. Website URL
   8. Story contact name
   9. Story contact phone
   10. Story contact email
5. Consent

   • I am providing the information in this form to the department for the purpose of publication, including publication online.
   • I understand that publication of the information I have provided in this form on the internet may mean that it is transferred overseas, and I consent to that transfer.
   • I have obtained consent to the publication and overseas transfer of the personal information of all persons whose images and personal information are contained in my submission.

   1. Consent: *

      • Yes, I provide my consent.
6. Take the pledge

   • I am authorised to take the pledge to end domestic and family violence on behalf of my organisation.

   1. Pledge: *

      • Yes, I am authorised to take the pledge.