Forms and Policies

Applications for New Programs and Renewal of Existing Approved Programs

(Updated March 2021)

Agencies seeking Committee approval to become a new state-approved provider of domestic violence offender intervention services AND existing state-approved providers seeking program renewal must complete and submit the following application:

Program Application Information and Instructions

Program Application Form

Staff Changes / Additions

(Updated March 2021)

State-approved programs must obtain approval from the Committee prior to adding any new Program Supervisors, Direct Service Provider, Trainees, and/or Volunteers to the state approved program. Please complete and submit the appropriate application(s) when seeking Committee approval:

Application for New Program Supervisor

Program Supervisor Application Information and Instructions

Program Supervisor Application Form

Application for New Direct Service Provider

Direct Service Provider Application Information and Instructions

Direct Service Provider Application Form

Application for New Trainee

Trainee Application Information and Instructions

Trainee Application Form

Telecommunication Services

Approved Offender Intervention service providers seeking to offer telecommunication services must complete and submit the following application for Committee approval:

Telecommunication Services Policy

Application

Remote Supervision

Approved Offender Intervention Program Supervisors seeking to provide temporary remote supervision of a domestic violence offender intervention program to qualify program supervisors and direct service providers must complete and submit the following application for Committee approval:

Remote Supervision Policy

Application

Additional Forms

Program Address Change Form

Signed Statement Form