Below is a sample of the emails you can expect to receive when signed up to Human Trafficking Hotline.
| Data Name | Data Type | Options |
|---|---|---|
 Text Box | ||
| First name | Text Box | |
| Last name | Text Box | |
| Title | Text Box | |
| Password | Text Box | |
| Text Box | ||
| Phone (mobile) | Text Box | |
| Phone | Text Box | |
| City | Text Box | |
| State | Text Box | |
| Country | Text Box | |
| Password (confirm) | Text Box | |
| Gender | Text Box | |
 checklist | ||
 button | ||
| Preferred Gender Pronouns |  dropdown | Please select... |
| How did you learn about the Hotline? | dropdown | Please select... |
 option | Is the Staff Point of Contact the same as the person completing this form? | |
| option | Yes | |
| dropdown | Please select... | |
| dropdown | Please select... | |
| option | Please select... AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MP - Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New | |
| option | Yes | |
| option | No Do the other locations have different referral methods and/or different services offered? | |
| option | Yes (If yes, it is best to complete separate applications for each location) | |
| option | Type of Organization | |
| option | Nonprofit | |
| option | Government Agency | |
| option | Other Provider Type | |
| option | Government Agency | |
| option | Direct Services Agency | |
| option | Indirect Services Only | |
| option | Does your agency offer services to victims of trafficking, either directly or through a stable MOU? | |
| option | Yes | |
| option | No Does your agency provide resources or opportunities for the anti-human trafficking community, such as training, awareness, or volunteer opportunities related to human trafficking? | |
| option | Yes | |
| checklist | Select the Topics below that most resemble your Mission or Purpose (Select all that apply) | |
| checklist | Anti-Trafficking | |
| checklist | Crime Victims | |
| checklist | Labor Exploitation | |
| checklist | Sexual Abuse/Assault | |
| checklist | Domestic Violence | |
| checklist | Runaway/Homeless Youth | |
| checklist | Select all languages your organization have capacity to speak, without the use of a tele-interpretation service | |
| checklist | English | |
| checklist | Spanish | |
| checklist | Acateco/Akatek/Western Kanjobal | |
| checklist | Afrikaans | |
| checklist | Albanian | |
| checklist | American Sign Language | |
| checklist | Amharic | |
| checklist | Arabic | |
| checklist | Armenian | |
| checklist | Assamese | |
| checklist | Awadhi | |
| checklist | Azerbaijani | |
| checklist | Baluchi | |
| checklist | Bambara | |
| checklist | Belarusian | |
| checklist | Bemba | |
| checklist | Bengali/Bangla | |
| checklist | Bhojpuri | |
| checklist | Bicolano/Central Bikol | |
| checklist | Bisaya/Cebuano | |
| checklist | Bosnian | |
| checklist | Bulgarian | |
| checklist | Burmese | |
| checklist | Chhattisgarhi | |
| checklist | Chinese - Cantonese | |
| checklist | Chinese - Mandarin | |
| checklist | Chinese - Other/Unknown | |
| checklist | Chittagonian | |
| checklist | Chuukese | |
| checklist | Croatian | |
| checklist | Czech | |
| checklist | Dan | |
| checklist | Danish | |
| checklist | Dari | |
| checklist | Deccan/Dhankini | |
| checklist | Dhundari | |
| checklist | Dinka | |
| checklist | Dutch | |
| checklist | Dzongkha | |
| checklist | Estonian | |
| checklist | Ewe | |
| checklist | Fang | |
| checklist | Fijian | |
| checklist | Filipino | |
| checklist | Finnish | |
| checklist | Fon | |
| checklist | French | |
| checklist | Fulah | |
| checklist | Ganda/Luganda | |
| checklist | Georgian | |
| checklist | German | |
| checklist | Greek | |
| checklist | Gujarati | |
| checklist | Guyanese | |
| checklist | Haitian/Haitian Creole | |
| checklist | Hausa | |
| checklist | Hebrew | |
| checklist | Hiligaynon | |
| checklist | Hindi | |
| checklist | Hmong/Miao | |
| checklist | Hungarian | |
| checklist | Icelandic | |
| checklist | Igbo | |
| checklist | Iloko/Ilicano | |
| checklist | Indonesian/Bahasa Indonesia | |
| checklist | Italian | |
| checklist | Jamaican Patois | |
| checklist | Japanese | |
| checklist | Javanese | |
| checklist | K'iche'/Quiche | |
| checklist | Kalanga | |
| checklist | Kannada | |
| checklist | Kazakh | |
| checklist | Khmer | |
| checklist | Kimbundu | |
| checklist | Kinyarwanda | |
| checklist | Kongo/Kikongo | |
| checklist | Konkani | |
| checklist | Korean | |
| checklist | Kurdish | |
| checklist | Kyrgyz/Kirghiz | |
| checklist | Lao/Laotian | |
| checklist | Latvian | |
| checklist | Lingala | |
| checklist | Lithuanian | |
| checklist | Macedonian | |
| checklist | Maguindanaon | |
| checklist | Maithili | |
| checklist | Makhuwa/Emakhuwa | |
| checklist | Malagasy | |
| checklist | Malay | |
| checklist | Malayalam | |
| checklist | Mam | |
| checklist | Mandingo/Mandinka | |
| checklist | Marathi | |
| checklist | Masai | |
| checklist | Maya/Yucateco/Yucatec Maya | |
| checklist | Moldovan | |
| checklist | Mongolian | |
| checklist | Mossi | |
| checklist | Navajo | |
| checklist | Ndebele | |
| checklist | Nepali | |
| checklist | Norwegian | |
| checklist | Nyanja/Chewa | |
| checklist | Oriya/Odia | |
| checklist | Oromo | |
| checklist | Other | |
| checklist | Pashtu/Pushto | |
| checklist | Persian/Farsi | |
| checklist | Polish | |
| checklist | Portuguese | |
| checklist | Punjabi/Panjabi | |
| checklist | Quechua | |
| checklist | Rajasthani | |
| checklist | Romani | |
| checklist | Romanian | |
| checklist | Rundi/Kirundi | |
| checklist | Russian | |
| checklist | Samoan | |
| checklist | Sango | |
| checklist | Serbian | |
| checklist | Shona | |
| checklist | Sidamo | |
| checklist | Sindhi | |
| checklist | Sinhala/Sinhalese | |
| checklist | Slovak | |
| checklist | Slovenian | |
| checklist | Somali | |
| checklist | Sotho/Sesotho | |
| checklist | Sundanese | |
| checklist | Swahili | |
| checklist | Swedish | |
| checklist | Sylheti | |
| checklist | Syriac/Assyrian | |
| checklist | Tagalog | |
| checklist | Tajik | |
| checklist | Tamil | |
| checklist | Telugu | |
| checklist | Thai | |
| checklist | Tibetan | |
| checklist | Tigrinya | |
| checklist | Tshangla/Sharchhopka | |
| checklist | Tswana/Setswana | |
| checklist | Turkish | |
| checklist | Turkmen | |
| checklist | Twi/Asante | |
| checklist | Uighur | |
| checklist | Ukrainian | |
| checklist | Umbundu | |
| checklist | Urdu | |
| checklist | Uzbek | |
| checklist | Vietnamese | |
| checklist | Wolof | |
| checklist | Xhosa | |
| checklist | Yoruba | |
| option | Zulu Does your organization have access to a tele-interpretation service? | |
| option | Yes | |
| option | Please enter any additional information about your language capacity that may be useful those using our Directory to know SPECIALIZATIONS This section will help determine how your organization should be displayed in the National Referral Directory, as well as to help survivors identify organizations that specialize in their experiences. The information in this section will be shared with those reaching out to the hotline and may be displayed publicly if your organization opts to be displayed in the publ | |
| option | Human trafficking is the main focus | |
| option | Human trafficking of one of several focus areas | |
| option | My organization does not work specifically on human trafficking, but is equipped to help human trafficking victims Is your organization a faith-based organization? | |
| option | Yes | |
| checklist | No Specialization in Serving Vulnerable Populations Please only select the following specializations when it is part of your organization’s core mission/focus to serve these groups, resulting in particular expertise. It is assumed that agencies that do not “specialize” in serving these populations will still offer services to clients who identify with these populations and meet agency intake criteria. Select all "specializations" that apply: | |
| checklist | Specialization in serving LGBTQI | |
| checklist | Specialization in serving people with disabilities | |
| checklist | Specialization in serving American Indian and Alaskan Native | |
| checklist | Specialization in serving refugee/asylum-seekers | |
| checklist | Specialization in serving ethnic minorities | |
| checklist | Specialization in serving people with HIV/AIDS | |
| checklist | Specialization in serving religious, social, or political minority groups | |
| option | Specialization in serving homeless populations Organization Details Information in this section will be used during the review process to determine if your organization meets the minimum inclusion criteria for the National Referral Directory as well as to build context around how your organization provides services. The information provided here will be used for internal vetting purposes and will only be shared with those involved in the vetting process, which may include external stakeholders. | |
| option | Yes | |
| option | No How are services provided to human trafficking survivors? | |
| option | Only designated staff members serve trafficking survivors | |
| option | All staff members may serve trafficking survivors | |
| option | Volunteers with staff supervision serve trafficking survivors | |
| option | Does your organization have a formal confidentiality policy which protects client’s personal information from being released to external parties without the client’s permission, unless to the extent required by law? | |
| option | Yes | |
| option | NoIf yes, please upload file on last page Does your organization have a formal non-discrimination policy covering clients and prospective clients who meet service eligibility requirements of that organization? | |
| option | Yes | |
| option | Organization is governed by a board of directors | |
| option | Yes | |
| checklist | No Do you receive any of the following types of funding? (Check all that apply). Note: Information related to public funding may be viewable on our website if approved for the public directory | |
| checklist | OVC Human Trafficking Victim Services | |
| checklist | HHS Trafficking Victim Assistance Program (TVAP) | |
| checklist | HHS Human Trafficking Victim Services | |
| checklist | Other federal anti-trafficking funding | |
| checklist | State-level anti-trafficking funding | |
| checklist | Private anti-trafficking funding | |
| checklist | VAWA funding | |
| checklist | LSC funding | |
| checklist | VOCA funding | |
| checklist | Other federal funding | |
| checklist | Other state funding | |
| checklist | Other private funding | |
| checklist | Other | |
| option | Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org. REFERRAL METHODS This section contains the critical information needed to make referrals smoothly, in the quickest way possible. We recognize that sometimes the best referral method, especially for after hours emergencies, is a private phone number. Please carefully note at the bottom of the page which contact methods are public and available to sha | |
| option | Available only by calling the National Hotline | |
| option | Available on the public online database and by calling the hotline If you wish to be displayed on the public version of the Directory and any of your referral methods are private, please select the most appropriate disclaimer to displayed on the public Directory | |
| option | Anyone seeking emergency services at any time of day should contact the National Hotline to connect to our services | |
| option | Anyone seeking emergency services after hours should contact the National Hotline to connect to our services | |
| checklist | Please specify which of the above contact methods are public (Check all that apply). | |
| checklist | Main Number (from first page) | |
| checklist | Primary Referral Phone | |
| checklist | Secondary Referral Phone | |
| checklist | Tertiary Referral Phone | |
| checklist | Text Line | |
| checklist | Primary Email | |
| checklist | Secondary EmailContact methods that are made publicly available will be posted on the website (if you chose to be public) and/or given to callers who reach out to the Hotline. Contact methods not marked here will remain private for use by Hotline Advocates directly connecting callers to your organization for referrals. Which of the above contact methods are available 24/7 (Check all that apply). | |
| checklist | Main Number (from first page) | |
| checklist | Primary Referral Phone | |
| checklist | Secondary Referral Phone | |
| checklist | Tertiary Referral Phone | |
| option | Select Accepted Referral Methods | |
| option | Self-Referral in addition to community and professional referrals | |
| option | From Law Enforcement or Criminal Justice System Only | |
| option | From other Service Providers and Law Enforcement Only Can you accept referrals from the Hotline? By being included in the National Referral Directory, it is expected that your organization will accept referrals from the National Hotline. If you can not accept referrals from the Hotline then there is no need to proceed with the application. | |
| option | Yes | |
| checklist | INTAKE PROCESS Select all that Apply to Your Organization's Intake Procedures | |
| checklist | Screens for Eligibility (Note Eligibility Requirements on next page) | |
| checklist | Screens for trafficking at intake, as a condition of being accepting them into the program | |
| checklist | Screens for trafficking at intake, but acceptance into program is not reliant on complete screening | |
| checklist | Conducts Background Checks | |
| checklist | Will Involve Law Enforcement | |
| checklist | Same-day intake available | |
| checklist | Intake process is not immediate/same-day | |
| checklist | Intake must be completed in-person | |
| checklist | Telephone/Video/other remote intake available | |
| option | Are you willing to upload your screening tool for the NHTH to review and use to inform the referral process? (will not be shared externally unless given explicit permission) | |
| option | Yes | |
| checklist | Geographic Service Area is valid | |
| checklist | Eligibility and Program Requirements Eligibility Requirements Choose all that apply from each demographic section. Please select all demographic options that are considered eligible for your services. At least one selection from each section must be made. Eligible Demographics* Age (Indicate specific age range in Population Served Notes if applicable): | |
| checklist | MinorIf populations you serve for any services are under 18, please select "Minor" | |
| checklist | Adult (18+) If populations you serve are 18 and over, please select "Adult." Gender: | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female Nationality: | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National Type of Trafficking: | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking If you selected that you serve Foreign Nationals, are there specific visa types that you are restricted to work with? (select all that apply) | |
| checklist | The organization will serve all foreign nationals, regardless of documentation status or visa type | |
| checklist | The organization will serve all foreign nationals, but must have legal documentation | |
| checklist | The organization will serve J-1 Visa Holders | |
| checklist | The organization will serve H-2A Visa Holders | |
| checklist | The organization will serve H-2B Visa Holders | |
| checklist | The organization will serve H-2B (Forestry) Visa Holders | |
| checklist | The organization will serve A-3 Visa Holders | |
| option | The organization will serve G-5 Visa Holders Are you willing to serve someone who identifies as a sex worker or is engaging in commercial sex, even if they may not identify as a victim of human trafficking or present indicators of human trafficking? | |
| option | Yes | |
| option | No, Are you willing to serve someone who has been exploited for labor, even if they may not identify as a victim of human trafficking or present indicators of human trafficking? | |
| option | Yes | |
| checklist | The organization can serve clients... (Select all that apply) | |
| checklist | Who are currently using substances | |
| checklist | Who are actively detoxing | |
| checklist | With a history of substance use | |
| checklist | With non-felonious criminal records | |
| checklist | With felony criminal records | |
| checklist | With criminal records that include sex offenses | |
| checklist | With accompanying dependents | |
| checklist | With an accompanying pet | |
| option | Program Requirements Are clients expected to engage in faith-related activities as part of service delivery? | |
| option | Yes | |
| checklist | Please select all that apply related to what potential clients can expect if accepted into your program: | |
| checklist | The organization allows clients to keep their cell phones | |
| checklist | The organization allows clients to use their cell phones | |
| checklist | The organization allows clients to use social media | |
| checklist | The organization has a curfew (if offering shelter services) | |
| checklist | The organization requires clients to leave the facility during certain hours (if offering shelter or housing services) | |
| checklist | The shelter/housing has private sleeping arrangements for clients (everyone does not sleep in the same area, but clients may have a roommate) | |
| checklist | Clients will have their own private sleeping space that is not shared with another client (if offering shelter or housing services) | |
| checklist | The organization requires clients to be employed or actively seek employment if accessing services | |
| checklist | The organization requires clients to help with chores (if offering a shelter or housing service) | |
| checklist | The organization has other required programming or activities (please explain below) | |
| checklist | Additional Accessibility Information Please select all that apply regarding your organization's accessibility. If you would like more information on accessibility and Americans with Disabilities Act (ADA) best practices, visit ADA.gov | |
| checklist | Can support survivors who are blind | |
| checklist | Can support clients who are deaf | |
| checklist | Will accept a client accompanied by a service animal | |
| checklist | Has an Accessible Entrance | |
| checklist | Has Accessible Routes To All Service/Activity Areas | |
| checklist | Has Accessibility within Toilet Rooms | |
| checklist | Has Accessible Ramp Features | |
| checklist | Has staff or volunteers who communicate in American Sign Language (ASL) | |
| checklist | Has accessible shelter beds (if applicable) | |
| checklist | Has accessible elevators (or does not have multiple levels requiring stair access) | |
| option | Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org. Services for Victims of Trafficking SERVICES OVERVIEW Does your organization provide long-term care to survivors of trafficking (defined as direct services for a period of more than one year)? | |
| option | Yes | |
| checklist | NoDo not select if you only provide long-term care through an MOU with another organization. SERVICES OFFERED Please select all of the services you offer directly or through a stable MOU. Due to the purpose of our Referral Directory, it will be assumed that all services listed will be available to survivors and victims of human trafficking.Notes are required for each service, as they are very helpful for our Hotline Advocates when making referrals and provides viewers of our public Referral Directory wi | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Case Management | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Child Care | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Crisis Services | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Drop-In Center | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different subset of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Education/Job Training | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Emergency Shelter | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Family Reunification | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Health Care | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Interpretation/Translation | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Legal Services - Civil | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Legal Services - Criminal | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Legal Services - Immigration | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Long-term Housing | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Mental Health Services (Out-Patient) | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Repatriation | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Residential Mental Health Treatment (In-Patient) | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Supportive Counseling | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Survivor Leadership | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Transitional Housing | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Transportation Assistance | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Additional Shelter Details If your organization provides overnight shelter or housing to clients, please complete the following questions. How is shelter provided? | |
| checklist | Onsite | |
| checklist | Offsite, but managed by organization | |
| checklist | Via MOU with another agency | |
| checklist | Hotel/motel points | |
| checklist | Community Placement | |
| option | Other Is your organization licensed as a housing/shelter facility? | |
| option | Yes | |
| checklist | Type of facility providing residential care for minors (check all that apply): | |
| checklist | Emergency shelter | |
| checklist | Runaway and homeless youth center | |
| checklist | Community-based group home | |
| checklist | Campus-style group home | |
| checklist | Secure facility | |
| checklist | “Staff Secure” facility | |
| checklist | Foster/Host family placement | |
| checklist | Resources and Opportunities in the Anti-Trafficking Community Select each of the services you offer related to the anti-trafficking community. Outreach/Awareness | |
| checklist | Please select which human trafficking topics your outreach and awareness activities relate to: | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Training | |
| checklist | Please select which human trafficking topics your training services relate to: | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Volunteer Opportunites | |
| checklist | Please select which human trafficking topics this volunteer opportunity relates to: | |
| checklist | Labor Trafficking | |
| checklist | Sex Trafficking Other Services - please describe | |
| option | Populations Served | |
| option | Same populations as on page 5 | |
| checklist | This service is offered to a different set of populations Please select all applicable from each category: age, gender, nationality, and type of trafficking | |
| checklist | Minor | |
| checklist | Adult | |
| checklist | Female | |
| checklist | Male | |
| checklist | Transgender Female-to-Male | |
| checklist | Transgender Male-to-Female | |
| checklist | US Citizen/Legal Permanent Resident | |
| checklist | Foreign National | |
| checklist | Labor Trafficking | |
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