NYS LGBTQ IPV Network Application[vc_row centered=”yes”][vc_column][vc_column_text]MISSION:The Network seeks to raise awareness of and improve response to intimate partner violence impacting LGBTQ communities throughout the state. The Network supports service providers, advocates, policymakers and others by providing education and advocacy, fostering collaboration, and identifying and working towards needed change. These efforts will enhance the availability and delivery of services while promoting advocacy on behalf of those affected by intimate partner violence in LGBTQ communities.General InformationName of Organization*Main Contact for Organization*Address of Organization Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneFax NumberEmail Name and Email Addresses of Other Participants in AgencyMember ProfileThe NYS LGBTQ Intimate Partner Violence Network works to continuously improve responses to intimate partner violence impacting LGBTQ people throughout the state. For this reason, it is helpful to measure and assess the concrete steps we take internally towards this vital work in expansion.In order to measure and assess progress, strengths, and areas of growth, members must first provide self-locating and self-reflective information on the organization’s or individual member’s actions taken or plans made in terms of increasing its accessibility to LGBTQ people.Describe the mission and vision of your organization, your program, and/or your individual work. If your program has its own mission and/or vision, please describe them in this space.Describe the structure of your organization so that the Network can better understand the relationship between your program and the organization as a whole and what your technical assistance needs might be. If you are an individual member, please move onto the next question.Describe, in detail, the services that you/your organization provide(s).Describe the work you/your organization has already done to enact affirming and inclusive policies for LGBTQ people who may be accessing services for survivors of intimate partner violence, on staff, volunteering, or otherwise interacting with your organization. Describe the work that you/your organization has already done to increase access to affirming and inclusive programming and services for LGBTQ survivors of intimate partner violence.Describe potential barriers to enacting inclusive policy or direct client services or programing for LGBTQ survivors of intimate partner violence. Describe any potential areas of need for technical assistance in overcoming these barriers.NYS LGBTQ Intimate Partner Violence Network CommitteesPlease choose at least one committee that your organization would like to join. Committee members are asked to actively participate in the work of that committee by attending monthly calls and communicating via email.Please choose at least 1 committee. Practice & Policy Committee: The committee strategizes around advocacy, support and implementation of policies that impact LGBTQ survivors of IPV statewide. Shelter Access Committee: The committee works to support fair access to Intimate Partner Violence shelters for LGBTQ and especially Trans and Gender Non-Conforming survivors of IPV through information sharing, education and advocacy. Steering Committee: This committee works to maintain the organization and management of the NYS LGBTQ IPV Network, as well as expanding the membership base and strengthening in-network collaboration.Membership Points of AgreementIn order to apply for membership, please carefully review the mission located at the top of this application and check the below boxes to affirm your agency’s commitment to the following statements. This organization has read and fully supports the mission of the NYS LGBTQ Intimate Partner Violence Network. This organization commits to active participation in the NYS LGBTQ Intimate Partner Violence Network by: 1) attending the annual in-person meeting, 2) actively participating in at least one committee* and 3) participating in the bi-monthly general calls. *Active participation in a committee is defined as participation in at least 50% of the scheduled committee calls and participation in email conversations and committee tasks. If unable to attend a call communicate with committee co-chairs and take part in email conversations and committee tasks. This organization is committed to improving services for LGBTQ survivors of intimate partner violence and/or increase the understanding of issues related to intimate partner violence in LGBTQ communities in New York State As a member of the NYS LGBTQ IPV Network, this organization will take active measures to increase the inclusion of LGBTQ survivors of intimate partner violence in this organization's available services, especially in regard to LGBTQ shelter access.Signature of ParticipantPlease type your name above - please note that typing your name serves as your signature on this document.Signature of Executive Director or Program Director of Agency ProgramsPlease type your name above - please note that typing your name serves as your signature on this document.Questions? Contact the Network Coordinator at info@avp.org or call us at 212-714-1184.Δ [/vc_column_text][/vc_column][/vc_row]
