(* indicates fields that are required).

*First name:   Middle initial:   *Last name 

Title:  
*Agency name:  
Agency name line 2:  
*Mailing address:  
Mailing address line 2:  
*City:  
*State/Territory/Province:  
*Zip  
*Work phone:  
   Fax:  
*E-mail:  
*Verify e-mail:  

Agency and Professional Information

*Job type (check the one that best fits your job or check other and explain.)
Administrator
Line Officer
Supervisor
Trainer
Other

Alternate description (if other is checked above)


*Years on the job (Check the category that best fits your current job.)
First year
1 - 5 years
6 - 10 years
11 - 16 years
over 16 years

*Approximately what portion of your job responsibilities involve domestic violence cases? (Check the category that best fits your current job.)
0
25%
50%
75%
100%

*Type of agency in which you work (Check the category that best fits your current job.)
Probation
Parole
Probation/Parole (combined)
Pretrial services
Domestic Violence Victim Advocate (community-based)
Victims Services (hired by a justice system agency)
Batterer Program
Criminal Court
Civil Court
Family Court
Prosecutor
Law Enforcement
Defense Bar
Child Protective Services
Substance Abuse Treatment
Mental Health Treatment
Other

If other is checked above, provide your best description of the type of agency you work for.


*Jurisdiction type
Urban
Rural