California Violence Prevention Resource Directory: Request to be added to the directory

Please fill out this form if you are an organization or agency that would like to request to be added to the Violence Prevention Resource Directory.

We appreciate your interest in becoming part of the Resource Directory.

Submitted requests will be considered for inclusion on a monthly basis. You will receive written notification if approved. Once added to the Resource Directory, you are responsible for submitting any changes to your agency's information, using the online Update Form, which you can access from our Resource Directory web page.

Contact Information

Contact Name

Email or Phone Number of Contact (This will not be published online. It is only for purposes of contacting you for updating the directory.)

Organization Name

Street Address

City, State, Zip

Organization's Email Address (General e-mail address, if applicable, for your agency, such as: 'info@agency.org'. This WILL be published in the directory.)

Organization's Phone Number(s) (Please indicate if the number is TTY/TDD equipped for the deaf.)

Organization's Fax Number

Hotline Number

Organization's Website

1. Under which category(ies) of services are you requesting to have your agency listed? (You may choose more than one.)
Required Question

	Domestic Violence Victim/PreventionServices
	Domestic Violence Shelter Services
	Sexual Violence (Rape) Victim/Prevention Services
	Victim/Witness Services
	Adult Protective Services
	Child Protective Services
	Batterer's Intervention Programs (Approved)

2. What county(ies) are your services provided in? (You may choose more than one.) Required Question

3. Comments or Questions?

Alameda	Alpine	Amador
Butte	Calaveras	Colusa
Contra Costa	Del Norte	El Dorado
Fresno	Glenn	Humboldt
Imperial	Inyo	Kern
Kings	Lake	Lassen
Los Angeles	Madera	Marin
Mariposa	Mendocino	Merced
Modoc	Mono	Monterey
Napa	Nevada	Orange
Placer	Plumas	Riverside
Sacramento	San Benito	San Bernardino
San Diego	San Francisco	San Joaquin
San Luis Obispo	San Mateo	Santa Barbara
Santa Clara	Santa Cruz	Shasta
Sierra	Siskiyou	Solano
Sonoma	Stanislaus	Sutter
Tehama	Trinity	Tulare
Tuolumne	Ventura	Yolo
Yuba