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<br />12) Check which service model best describes your program: (Check one only) <br /> <br /> <br />Sexual Assault - Medical <br />Sexual Assault - Non-Medical . <br />Spouse Abuse - Shelter or Safe House <br />Spouse Abuse - Non-Shelter <br />Child Abuse - Intrafamilial <br />Child Sexual Abuse <br />Child Victimization - General <br />Crimes of Violence <br />Adult Victimization - General <br />Comprehensive - Crisis Intervention <br />Comprehensive - General <br />Victim Witness - Prosecution Services <br />Other (Identify) <br /> <br />13) IdentifY the victims to be served through this VOCA funded project (VOCA grant plus match) by checking the type of crime(s): <br /> <br />Child Physical Abuse <br />Child Sexual Abuse <br />DUI/DWI Crashes <br />Domestic Violence <br />Adult Sexual Assault <br />Elder Abuse <br />Adults Molested as Children <br />Survivors of Homicide Victims <br />Robbery <br />Assault <br />Other Violent Crimes (Identify) <br />Other (Identify) Harassment, Burglary, Disorderly Conduct, Terrorizing <br /> <br />14) Check the services to be provided by this VOCA funded project (VOCA grant plus match): <br /> <br /> <br />Crisis Counseling <br />Follow-up Contact <br />Therapy <br />Group Treatment <br />Crisis Hotline Counseling <br />Shelter/Safe House <br />Information and Referral (in person) <br />Criminal Justice Support/Advocacy <br />Emergency Financial Assistance <br />Emergency Legal Advocacy <br />Assistance in FIling Compensation Claims <br />Personal Advocacy <br />Telephone Contacts (Information/Referral) <br />Other (Identify) <br /> <br />2 <br />