EmailMe Form - USWT Domestic Violence Awareness Transmittal

USWT Domestic Violence Awareness Transmittal

Each educational, fundraising or service project for Domestic Violence Awareness should be submitted on this form. Maintain a copy for your chapter files. Final submissions must be completed no later than May 1.

Responses to the online form will be viewed by the USWT Domestic Violence Awareness Program Manager, and your state contact. Fill in as much information as you know. Upon completion of the form, click Submit; you will receive a confirmation screen if your form has been successfully submitted. (rev 2017)

Your Email *
State *
Other State
If you are a member of a state organization not listed, please enter your state.
Chapter *
Name *
First Last
Enter the name of the DVA program manager or project chair
Phone
### - ### - ####
Address

Street Address City State / Province / Region Postal / Zip Code
Date Submitted *
MM / DD / YYYY
Project Name *
Project Type *
Educational
Fundraising
Service
Other
Check all that apply
Project Type Other Explanation *
If you chose "other" in the Project Type, please explain
Donation Recipient Name
Enter the name of your donation recipient
Donation Recipient Type
Speaker
Shelter
DVA Agency
Other
Check all that apply
Donation Recipient Other Explanation *
If you chose "other" in the Donation Recipient Type, please explain
Recipient Description
Please describe the organization for which this event was benefitting
Amount Raised *
$ Dollars . Cents
Enter the estimated total amount raised; if no monies were raised, enter zero ($0.00)
Amount Donated *
$ Dollars . Cents
Enter the estimated total items donated; if no monies were donated, enter zero ($0.00)
Service Hours *
Enter the total service hours for this project; this number should NEVER be zero (o); multiply the number of participants by the number of hours for the project
Project's Donation Date
MM / DD / YYYY
Project Description *
Please supply a description of the DVA event