Domestic Violence Program New Member Application

14% of survey complete.

Our Vision

By 2020, the Colorado Coalition Against Domestic Violence (CCADV) will be the trusted and valued state leader in expanding the capacity of Colorado's domestic violence programs, allied professionals, policymakers, and the public to dramatically reduce domestic violence in the state.

Through training, technical assistance, resources and support, CCADV helps build the capacity of domestic violence program members and allied professionals to meet the needs of the survivors and communities they serve. We increase safety and support for survivors by engaging in policy and systems change. We participate in and build coalitions to create change through our collective voice, and serve as Colorado’s resource center for reliable resources on issues related to domestic violence. We are here to support and represent you.

Thank you for your interest in CCADV membership. The 2014 dues for domestic violence programs are .3% of your annual domestic violence program expenses (minimum dues are $250, maximum are $1,000).

*Please note: If you need a copy of this form for your records, please print each page (using the print function in your web browser) before clicking next.

1. Program Name:

2. Contact Person and Title:

3. Contact Information:

4. Telephone Numbers:

5. Counties and/or Cities Served:

6. What year was your organization established?

7. Focus of Organization:

8. Please provide the name and email address of all staff members who should be subscribed to the CCADV MEMBERS email listserv.

9. Please provide the name and email address of all staff who should be subscribed to the CCADV LEGISLATIVE email listserv.

10. Please provide name and email address of the Director who should be subscribed to the CCADV Directors listserv.

11. Are you aware of the types of training and technical assistance that CCADV can provide to you?

12. I agree that my name and title entered below constitutes my electronic signature and that I am authorized to complete this application for my organization.