* 1. First Name

* 2. Last Name

* 3. Job Title

* 6. Agency email

* 7. Phone Number

* 8. Is your agency signing U-visa certifications?

* 9. If "No," what information can be provided during the roundtable to assist you and your department in developing a certification program?

* 11. How many years has your agency been signing U visa certifications?

* 12. What topics or questions would you like to discuss at these monthly roundtables?

* 13. OVW and/or STOP Grant Funding: Grant type
My organization receives the following types of OVW and/or STOP funding, as a grantee OR as a subgrantee:

* 14. Accessibility (Optional)
Please check all that apply and specify details in other box: