Organization name * Organizational contact (for MapYourVoice representative) Org contact first name * Org contact last name * Org contact phone number * Org contact email address * Public contact (for Survivors) Main phone number * Website Service address Country - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Address 1 Address 2 City State - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code Is your service address kept confidential for security purposes? * - Select -YesNo TTY number Hotline number Text hotline number Toll-free number Information about your organization Service hours * Service area (locations served) * Legal entity type * - Select -For profit companyNonprofitGovernmentalOther (please specify)... Legal entity type Other (please specify)... Do you have legal nonprofit status? * - Select -YesNoHave fiscal sponsor Federal Employer Identification Number (FEIN, Tax ID #) Does your organization charge for services to sexual violence survivors? * - Select -YesNoSliding scale (income based)Other (please specify)... Does your organization charge for services to sexual violence survivors? Other (please specify)... Organization type (check all that apply) * Law enforcement (police) District attorney Social health and welfare services Hospital/Emergency Medical Legal services Shelter Safe haven Counseling/therapeutic services Child Protective Services Adult Protective Services (for seniors and disabled adults) Religious-based services Advocacy organization Other (please specify)... Organization type (check all that apply) Other (please specify)... Support topic (check all that apply) * Domestic violence Child sexual abuse (CSA) Adults molested as children (AMAC) Sexual Assault/Rape Campus/student sexual assault Elder sexual abuse Sex Trafficking Forced Prostitution Sexual assault in conflict (war zones) Immigrant/refugee welfare/rights Specific racial/ethnic/religious group welfare/rights Victim services/advocacy Legal/criminal justice system advocacy Suicide prevention Homelessness Other (please specify)... Support topic (check all that apply) Other (please specify)... Populations served (check all that apply) * LGBT(Q) Teens Children Families Women Men People with disabilities Elderly Adults Students Employees Military personnel Prisoners Refugees Undocumented migrants Homeless Families of victims Poor Other (please specify)... Populations served (check all that apply) Other (please specify)... Types of services offered (check all that apply) * Hotline (phone/online chat) 24 Hour Crisis Intervention Individual Counseling Group Counseling/Support Groups Legal/Criminal Justice System Advocacy Crime Victim Assistance/Advocacy Community education/resources Risk Reduction Programs Professional Education Child Abuse Treatment Program Casework/Practical Assistance Medical/health care Governmental resources Other (please specify)... Types of services offered (check all that apply) Other (please specify)... Languages served besides English (check all that apply) Spanish Chinese (Mandarin) Chinese (Cantonese) Tagalog (including Filipino) Vietnamese Arabic French Korean Russian German Haitian Hindi Portuguese Italian Polish Urdu Japanese Persian (including Farsi and Dari) Gujarati Telugu Bengali Tai–Kadai (including Thai and Lao) Greek Punjabi Tamil Armenian Serbo-Croatian (including Bosnian, Croatian and Serbian) Hebrew Hmong Bantu (including Swahili) Khmer Navajo Other (please specify)... Languages served besides English (check all that apply) Other (please specify)... Organizational mission/charter * Additional information
