Request Technical Assistance

I have read and understand the above information.* I have read and understand the above information.* Yes No

Are you a member of NCVLI's National Alliance of Victims' Rights Attorneys & Advocates (NAVRA)?* Are you a member of NCVLI's National Alliance of Victims' Rights Attorneys & Advocates (NAVRA)?* Yes No

Name*

Agency/Firm/Organization*

Agency/Firm/Organization Website*

Street Address*

City*

State* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip*

Phone*

Email*

Does your agency receive state or federal funding?* Does your agency receive state or federal funding?* Arizona Enforcement OVC RISE Rights Enforcement OVW Other (explain below):

Grant Number(s):

If your agency receives OVW funding, what discretionary or formula grant program funding do you receive?

Your Profession:* Your Profession:*Advocate - Non-Profit/Community BasedAdvocate - System BasedAdvocate - Military BasedAdvocate - OtherAttorney - For VictimsAttorney - ProsecutorAttorney - Military (SVC/VLC)Attorney - OtherCourt Personnel (non-judge)Government Agency Staff - FederalGovernment Agency Staff - StateJudgeLaw EnforcementLegislatorMental Health/MedicalParalegalProgram CoordinatorProgram ManagerPublicStudent - LawStudent - OtherOther (specify below):

Other Profession (if selected above):

How did you find out about NCVLI? Select all that apply.* How did you find out about NCVLI? Select all that apply.* Brochure/Newspaper Individual (name below): Law School NCVLI is assigned TTA Provider Non-Profit/Service Organization (name below): Previously Received NCVLI's Assistance Training Web Search Other (explain below):

Other/Individual/Organization (if selected above):

Brief Description of Request (do not provide NCVLI with individually identifiable information):*

Which issue or stage of proceeding are you requesting assistance with?* Which issue or stage of proceeding are you requesting assistance with?* Legal Issues - Pretrial Legal Issues - Trial Legal Issues - Post Trial/Appeal Legislative or Public Policy Work Program - Development Program - Evaluation Program - Marketing/Outreach Technology Development Training - Development Training - Evaluation Other (explain below):

Other issue or stage of preceeding (if selected above):

What is the PRIMARY victim legal issue you are requesting assistance with related to?* What is the PRIMARY victim legal issue you are requesting assistance with related to?* Right to be heard Right to be present Right to fairness Right to information Right to notice Right to privacy Right to prompt disposition Right to protection Right to refuse discovery Right to restitution Right to support person Right to accommodations Right to Interpreter Other (explain below):

Other primary victim legal issue (if selected above):

Deadline and timing constraints:* Deadline and timing constraints:* Yes, I have a deadline or timing constraint No, I do not have a deadline

Please give us the date, time and a brief explanation of your deadline (or enter n/a if not applicable):*

Type of Assistance Requested* Type of Assistance Requested* Legal - Amicus Curiae Support Legal - General Information Legal - Sample Pleading Legal - Written Memorandum Legal - Strategic Advice Legislative - Sample Language or Strategic Advice Program Development Referral - to Attorney/Advocate/Expert Training - Creation, Evaluation, Marketing Other (explan below):

Other type of assistance (if selected above):

Predominant Victim Population(s) Impacted by Request:* Predominant Victim Population(s) Impacted by Request:* All Children Disabilities Elderly Ethnic Minority Immigrant International LGBT Men Military or Military Connection (e.g. dependent, civilian employee) Native Person(s) of Color Student Trafficked Persons Women Other (explain below):

If a military TA request, identify which justice system(s) may be navigated for this issue. If a military TA request, identify which justice system(s) may be navigated for this issue.Not ApplicableMilitary Justice SystemCivilian Justice SystemMilitary and Civilian Justice System

If a military TA request, identify the relevant branch of military service. If a military TA request, identify the relevant branch of military service.Not ApplicableU.S. Air ForceU.S. ArmyU.S. Coast GuardU.S. Marine CorpsU.S. Navy

Other impacted victim population (if selected above):

We have a few additional questions if your request is related to a particular case or victimization; if not, you may select n/a below and leave the rest blank. We have a few additional questions if your request is related to a particular case or victimization; if not, you may select n/a below and leave the rest blank. N/A

Case Name/#:

Identify the jurisdiction impacted by your request:* Identify the jurisdiction impacted by your request:* State Federal Military Tribal Campus Other (please specify):

Please specify other jurisdiction (if selected above):

What criminal offense or conduct is responsible for the underlying victimization. Select all that apply.* What criminal offense or conduct is responsible for the underlying victimization. Select all that apply.* Assault/Battery DUI/DWI Domestic Violence Adult Domestic Violence Child Fraud Hate Crime Homicide Identity Theft Kidnapping Sexual Assault - Adult Sexual Assault - Child Sexual Abuse of Children Images (Child Pornography) Stalking Theft of Property Trafficking - Domestic - Labor Trafficking - Domestic - Sex Trafficking - International - Labor Trafficking - International - Sex Other (explain below):

Please specify other criminal offense or conduct (if selected above):