VVAA Application 2018-2019

Welcome! We are pleased with your interest in the Vermont Victim Assistance Academy. Please complete this application after you have read and understand the Program and Application Information on our website.
 
The application deadline is Monday, October 1, 2018 at 4:30 pm. Thank you for your application.

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* 1. Name (first and last)

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* 2. Phone Number

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* 3. Email Address

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* 4. Please identify the role you would represent as a participant in the VVAA:

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* 5. Name of Agency (and Department) or Organization. If unaffiliated, please enter "Community Member".

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* 6. Position Title. If unaffiliated, please enter "Community Member"

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* 7. Mailing Address

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* 8. How did you hear about the Vermont Victim Assistance Academy?

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* 9. Please indicate your interests in this training in regards to working with victims of crime. Please check all that apply:

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* 10. For what type of organization do you work? Please check all that apply.

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* 11. Your agency or organization primarily serves clients in which types of communities? Please check all that apply.

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* 12. How long have you been working or studying in your field?

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* 13. In what context might you come in contact with and/or serve victims or survivors of crime or offenders/responsible parties?

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* 14. The following question will help us understand your goals and intentions for completing the VVAA. Please include any information you believe is important for the participant selection committee to consider.

Please use 100 words or less to summarize how your participation in the VVAA will be a benefit to you, your organization and/or your community.

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* 15. The Vermont Victim Assistance Academy is accredited for credentials and credits by three distinct entities. Please indicate which of the following, if any, you are interested in receiving upon completion of the VVAA.

NOTE: Students participating for course credit (VT State Colleges) are not eligible for a course fee waiver and there is an additional administrative fee of $100 per credit.

Please check the box below to indicate your interest in receiving credit for this course. Please check all that apply.

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* 16. If you are NOT interested in a course fee waiver, please mark the appropriate box below.

As stated in the Program and Application Information, each participant must pay the nonrefundable Confirmation of Enrollment amount of $50 upon acceptance into the program in order to reserve a place in the VVAA.

Waivers are available for those who are unable to pay the remaining course fee of $200 (or $50/session), either partially or in full. To receive a course fee waiver, please complete this section in full.

NOTE: Students earning course credit are NOT eligible to receive a course fee waiver, in part or in full; and will be expected to pay an administrative fee of $100 per credit.

Please check one:

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* 17. If you are requesting a partial or full course fee waiver, please explain the circumstances for your request in 100 words or less:

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* 18. Request for accommodations: Do you have specific dietary needs or requests for accommodations? Please describe your request in the box below. Thank you.

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* 19. Applicant Signature:  This survey must be complete in order for your application to be considered.
Participation in this program will require the following commitments, outlined further in the Participant Agreement:
- Attendance at the full 8-day course of the VVAA, or each 2-day session held from November 2018 through May 2019.
- Completion of all readings, evaluations and other assignments, up to 20 total additional hours beyond the in-person training.
- Responsibility for any travel arrangements, hotel accommodations and lunch, as needed.

By typing your name in the space below, you verify that all information given is accurate to the best of your knowledge, and that any false information will be sufficient cause for dis-allowance of your application.

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* 20. Applications are not considered complete until all required materials are submitted. The Participant Agreement and signed support for learning letter can be submitted via mail or email.
Vermont Center for Crime Victims Services
Community Engagement and Training Department
58 South Main Street, Suite 1
Waterbury, VT 05676
outreach@ccvs.vermont.gov

Please be sure you have completed all of the following:

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