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IPSA SURVIVOR-FRIENDLY DOMESTIC VIOLENCE SERVICES DATABASE
Please use the form below to put information about your service into the Faith-based Services Database.
Your information will appear when you have submitted it and filled in the CAPTCHA Spam-preventer.
Please note that you need to check the box that asks if you understand considerations about IPSA for your type of service (see Domestic Violence Service Considerations here), but you may leave any other field blank if it is not relevant.
However, please fill in as much as you can to ensure that survivors have sufficient information about your service.

Thank you so very much for your assistance with this project.

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Your service recognises Domestic Violence Service Considerations for IPSA and is an IPSA Survivor Friendly Service (Check for Yes)
Service Name:
Service Website Address?:
Country:
State/County/Region:
City:
E-mail Contact (if appropriate):
Phone Contact incl. area code (if appropriate):
Is there a Free Crisis Number?
Hours of Service Availability (Crisis Line, other; if different services/hours, start new line for each).
Cost of Services (please choose):	Free Costed Cost Dependent on Circumstances
If costed, do you wish to elaborate (for example, can a client get reduced costs if she has a referral)?
What types and modes of counselling does your service offer i.e. Crisis, short-term, long-term, telephone, face-to-face, email, online chat?
Counselling Approaches Used i.e. CBT, Psychodynamic, Feminist-based, Combination (Please elaborate)
Other Services Offered i.e Police advocacy, Support groups suitable for IPSA survivors, referrals to other community resources for abused women (Please elaborate):
Do you have a Message of Outreach for IPSA survivors who may seek out your service?
Other information about your service you think is necessary?

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