Exit this survey Non Residential Shelter Study 1. Default Section Please complete the information below if you are interested in having your organization participate in the 2010 national domestic violence study. Question Title * 1. Your name Question Title * 2. Organization Question Title * 3. City/Town Question Title * 4. Email Question Title * 5. Phone Question Title * 6. Please check all that apply I am the director or have the authority to commit my organization to participate in the study I am an advocate interested in bringing information about this study to my program I participated in the shelter study in 2008 and am familiar with how these studies work I volunteer to be the contact person for the study I volunteer to be a back-up contact person for the study Question Title * 7. If you are the director or other person authorized to sign up your program for the national study, please help us figure out how many surveys to send you, so that you’ll have enough for the 1st month.The surveys are for program participants (clients) who are not in shelter, not in immediate crisis, and have been to your program at least once. English Arabic Cambodian/Khmer Cantonese Chinese French Haitian Creole Hindi Japanese Korean Mandarin Chinese Polish Portuguese Russian Somali Spanish Tagalog Vietnamese Next