HIGH RISK CASE RESPONSE TEAM INFORMATION REQUEST

 

Name of Organization:

Contact Person:

Title:

Address:

City:

State:

Zip:

Telephone:

E-mail address:

How did you hear about us?

I am interested in learning more about High Risk Case Response Teams.
  Yes
  No

I want to start a High Risk Case Response Team in my area.
  Yes
  No

I have viewed the website including; published article; NNEDV video;and Three Year Report.
  Yes
  No

My agency has been trained on conducting risk assessments in DV cases.
  Yes
  No

If "Yes" on previous question, when did the training occur?

If "Yes" on previous question, who conducted the training?

My agency conducts regular risk assessments.
  Yes
  No

My agency has identified members for the High Risk Case Response Team in our area.
  Yes
  No

My agency currently has something in place such as a community round table or coordinated domestic violence response.
  Yes
  No