Applicant Assistant Resources
Safe at Home relies on Applicant
Assistants in the community to enroll participants
into the program. This program can be a piece of an overall safety plan. Without
Applicant Assistants (you) this program would not be able to exist.
An Applicant Assistant is an employee of
an organization/agency that provides
counseling and other services to victims of domestic violence, sexual assault,
stalking. Potential Applicant Assistants must complete the training (available
and be recertified annually to ensure they understand the program and can
thoroughly explain the benefits and responsibilities to applicants.
PROCESS: HOW YOU CAN BECOME AN APPLICANT
Director of the organization/agency must complete an
Organization Registration Form. Upon acceptance, this will establish
organization as an entity that can enroll applicants into the program. It
put them on the list (available on the website) of enrolling agents for
applicants to contact.
Employees of the Enrolling Agent must each complete an
This form will also require the signature of the Director who
signed the Enrolling Organization Registration Form. This will qualify
to take the training online and the quiz to become Applicant Assistants.
Both forms are available online. Print them, fill them out, sign them and
them to the Safe At Home Program Coordinator
by mail. They can all be
sent in together along with the training certificate of completion which
Assistants will receive after going through the online training. They can
sent separately. The Coordinator will contact the Director to verify organization
The training, which should take about 30 minutes, is a series of
slides interspersed with quiz questions along the way.
completion of the training, the trainee will be able to complete and print a
form to send to the Safe at Home Program Coordinator as proof of completion.
Coordinator will send confirmation of certification to the trainee. The
employee will then be qualified to enroll participants in the program.
Applicant Assistants are required, by law, to be recertified annually. The
Program Coordinator will send a notice to the Organization asking if the
Organization wants to continue to provide the service and which certified
will continue to provide the service.
The following resources can
be accessed from this page:
Organization Registration Form (to become an Enrolling
Organization, have your employees be eligible to become Applicant
Assistants, and be listed on the website as a resource for victims to enroll
Registration Form (to be qualified to take the training to
become an Applicant Assistant to enroll victims in the program)
Training (Before beginning the training module, print out the 3 forms below,
in the Enrollment Resources section, to use as a reference.)
beginning the training module, print out the 3 forms below, in the Enrollment
Resources section, to use as a reference.)
(Forms to enroll applicants in the
program. Print them, fill them out, get required signatures and mail them to the
Safe At Home Coordinator)
Confidentiality Program Application Form
Applicant Responsibilities Form
Co-Applicant Responsibilities Form (for
co-applicants over the age of 18)
To contact the Safe at Home
Program Coordinator with any questions about the program, call 802-828-0586, or
to e-mail, click here:
email@example.com The mailing address is PO Box 1568, Montpelier,