Domestic Violence Section Grantee E-mail Lists AGENCY SUBSCRIPTION FORMS

The purpose of the DVS grantee e-mail lists is to support one-way communication from DVS staff to key staff at DVS-funded agencies and programs. DVS hopes that the lists will build the capacity of participants to use electronic communications tools to accomplish programmatic goals and improve administrative efficiency. Please help us subscribe the correct staff to the lists by completing this form. All staff involved in the implementation of your DVS grant are eligible to participate on the e-mail list.

I.   Funding Type:   My agency is funded under the following DVS categories (check all that apply): Agency Name:   Shelter        Community Prevention   Prevention Planning   Unserved/Underserved

II.  Agency Staff to be on email distribution list Executive Director: Email: Program Manager: Email: Financial Officer: Email: Other: Email:

III.  Subscription Deletions

Name: Email: Name: Email: Name: Email: Name: Email: Name: Email:

Form Submitted by:  Emal: