Voca Grant Application - New Hampshire Department Of Justice Page 4

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C. ADDITIONAL REQUIRED INFORMATION
1.
For this victim services program indicate:
a.
Number of paid staff (full-time equivalents) _______
b.
Number of volunteer staff (full-time equivalents) ______
2.
Identify the victims to be served through this VOCA-funded program (VOCA grant
plus match) by checking the type of crime(s). Check all that apply:
a. ____ Child Physical Abuse
g. ____ Adults Molested as Children
b. ____ Child Sexual Abuse
h. ____ Survivors of Homicide Victims
c. ____ DUI/DWI Crashes
I. ____ Robbery
d. ____ Domestic Violence
j. ____ Assault
e. ____ Adult Sexual Assault
k. ____ Other Violent Crime
f.
____ Elder Abuse
l. ____ Other: ______________________
____________________________
3.
Identify the services to be provided by this VOCA-funded program (VOCA grant
plus match). Check all that apply:
a. ____ Crisis Counseling
h. ____ Criminal Justice Support/Advocacy
b. ____ Follow-up Contact
I. ____ Emergency Financial Assistance
c. ____ Therapy
j. ____ Emergency Legal Advocacy
d. ____ Group Treatment
k. ____ Assistance in Filing Victim’s
Compensation Claims
e. ____ Crisis Hotline Counseling
l. ____ Personal Advocacy
f.
____ Shelter/Safe House
m. ____ Telephone Contacts (info&referral)
g. ____ Information&Referral (In Person) n. ____ Other: ______________________
____________________________
Revised 10/99

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