California Violence Prevention Resource Directory: Update information currently listed in the directory
Page One
Please use this form if you are from an organization currently listed in the directory and you would like to update your information.
Thank you for taking the time to submit updated information about your agency. This information is vital to ensure that the directory is an accurate resource for users. Updates will be reviewed on a monthly basis and changes will be reflected in the online directory at that time.
Contact Information
Contact Name
Email or Phone Number for Contact (This will not be published online. It is only for purposes of contacting you about the updates.)
Your Organization's Name
Street Address
City, State, Zip
Your 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.)
Your Organization's Phone Number(s) (Please indicate if the number is TTY/TDD equipped for the deaf.)
Your Organization's Fax Number
Hotline Number
Your Organization's Website
1.
What category of services does your agency provide? (You may choose more than one.)
Domestic Violence Victim/Prevention Services
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 counties are your services provided in? (You may choose more than one.)
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
3.
Please tell us what incorrect information in the current directory you are changing with this form:
4.
Comments or questions?
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