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Submission of WA State STOP Formula Grant <br /> Renewal Application for FFY 2017 Funds <br /> Applications Due: October 2, 2017 <br /> No applications will be accepted after October 2, 2017 without prior written approval from Pearl <br /> Gipson-Collier,Section Manager,Violence Against Women Program, OCVA. <br /> Hard copy may be mailed or faxed (360-586-7176)to the attention of the Program staff for your county at: <br /> Violence Against Women Program <br /> Office of Crime Victims Advocacy <br /> WA State Department of Commerce <br /> Post Office Box 42525 <br /> Olympia,WA 98504-2525 <br /> Applications should be emailed to the OCVA Violence Against Women Program staff for your county <br /> as listed below. Staff will confirm receipt of your application. <br /> Anita Granbois Asotin, Garfield, Kittitas, Lincoln, Spokane,Thurston, <br /> Anita.Granbois@commerce.wa.gov Whitman,Yakima <br /> Ashley-Nicole Storey Cowlitz,Grays Harbor, Island,Jefferson, Kitsap, Klickitat, <br /> Ashley.Wancha@commerce.wa.gov Mason, Okanogan,San Juan, Skamania,Wahkiakum <br /> Cheryl Rasch Adams, Clallam,Clark, Ferry, Grant, King, Lewis, Pacific <br /> Chervl.Rasch@commerce.wa.gov Pend Oreille, Pierce, Stevens,Whatcom <br /> Jodi Honeysett Benton, Chelan, Columbia, Douglas, Franklin,Skagit, <br /> Jodine.Honeysett@commerce.wa.gov Snohomish,Walla Walla <br /> Checklist of Application Documents <br /> O Applicant Agency Information Complete <br /> 0 System for Award Management is current <br /> E Subgrantee Agency Information Provided, if applicable <br /> 0✓ Consultation with Victim Services Signed (Criminal Justice Applicants) <br /> ❑✓ Equal Employment Opportunity Certification <br /> Online verification provided; OR Certificate is attached <br /> ❑✓ Assurances Signed <br /> ❑✓ Federal Civil Rights Compliance Checklist <br /> Name of employee(s)who completed the training AND date training completed is provided <br /> Cl STOP Certification Requirements (Law Enforcement and Prosecutors) <br /> M Notice of Statutory Requirement to Comply with the Confidentiality and Privacy Provisions of the Violence <br /> Against Women Act, as Amended, Acknowledged and Accepted (Victim Services Providers) <br /> ❑✓ Coordinated Community Response Team Participation Form Completed <br /> ❑� Budget Worksheets Attached (use the Excel file provided with the application) <br /> Please note that all materials submitted as part of an application may be released pursuant to a request under <br /> the Freedom of Information Act. <br />