CCSS Community of Practice (CoP) signup for partners

First name *

Last name *

Organization name *

Please give the name of the organization you are with.

Pronouns *

If "other" pronoun please specify here

Job Title(s) *

What position(s) do you hold?

Work email *

Work phone number *

Are you involved in any Community Coordination initiatives? Check all that apply.

Interagency Case Assessment Team (ICAT)

Violence Against Women in Relationships (VAWIR)/Violence in Relationships (VIR)/Intimate Partner Violence (IPV) committee

Sexual Assault/Violence Coordination committee

Third Party Reporting (TPR)

Other coordination initiative if not listed above

If coordination initiative not listed please specify

If you are part of a Community Coordination committee or team, please specify role for each initiative (ie, chair, co-chair, member)

Anti-Violence Worker Support