WA State Department of Commerce 9/25/2017

Consultation with Victim Services (Criminal Justice Applicants) Everett Police Department Criminal justice applicants must consult with their local Community Sexual Assault Program (CSAP)and the Department of Social and Health Services(DSHS)Shelter Funded Domestic Violence Agency during the development of the criminal Justice application. This requirement is to ensure that proposed activities by criminal Justice agencies are designed to promote the safety and economic Independence of victims of domestic violence,sexual assault,stalking,and dating violence. As verification of this requirement,criminal justice agencies must discuss their STOP Grant activities with the appropriate victim services agencies and ask the authorized official to sign this form, In counties where the CSAP is separate;from the DSHS shelter funded domestic violence agency,applicant can print two copies of this form to enable both Executive Directors to respond and sign. Questions for CSAP and DSHS Shelter Agencies(please answer below and return this page to the criminal Justice applicant to be included in their application to OCVA: 1. Didyou participate in the development of this application? IS Yes ❑ No 2. Do you agree the proposed criminal justice activities promote the safety and economic independence of domesticviolence,sexual assault,dating violence or stalking victims(age 11 and older)In your Jurisdiction? ® Yes 0 No 3. If you do not agree the proposed activities are in the best interest of victims, have you been given the opportunity to provide feedback to the applicant? ® Yes ❑ No 4. If you provided feedback, are you satisfied that the application addresses issues you may have asked to be included? ® Yes ❑ No • Community Sexual Assault Program (CS )Name: Providence I tervention Center for Assault and Abuse _ �...._... ._/ e.� s ._ �✓ .... ._ Ol /(7 Signature o • AP Authorized Official Department of Social and Health Services(DSHS)Shelter Funded Domestic Violence Agency Name: Domestic Violence Services of Snohomish County _ Signature of DSHS Shelter Authorized Official CSAP/DSHS Agencies: If you answered "no"to any of the above,please provide details regarding the process and steps necessary to address concerns with the application. This space may be used to type comments.