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Department of Crime Victim Services 

Training, Provider Certification, and Statistical Analysis

 

Victim Service Provider (VSP) Application

* First Name 

MI 

* Last Name 

* Organization 

* Title 

* Agency Address  

Suite 

* City 

* State 

* Zip 

* Email 

* Contact Phone 


* Date of Hire: 


* County: 


Municipality: 


* Judicial Circuit 


* Employed With: 


For Credentialing Field, Please choose either:

"Basic VSP": Within 1 year of your start date you must complete the 15-hour basic training curriculum as outlined in "REQUIRED" for basic credentialing in order to complete the certification process and become a certified VSP.

"Notifier / Support Staff": You must complete the 2-hour Notifier/Support Staff training track every other year to maintain certification as a VSP-N.

"VSP-HT": Specialized training for approved VSPs whose role is solely or primarily providing services to Human Trafficking Victims. Within 1 year of your start date you must complete the Human Trafficking specialized 15-hour basic training curriculum as required by the Human Trafficking Task Force in order to complete the certification process and become a certified VSP-HT.

* Credentialing: 


Agency Supervisor Information (Please Click Add Additional Person - Required Field) 

* First Name 

MI 

* Last Name 

Title 

* Organization 

* Email 

* Work Phone 


Notice: CVST certification does not constitute licensure and is not to be construed as a warranty of the "applicant's" ability to deliver services. The applicant retains sole liability for any consequences stemming from deliberate falsehoods, misrepresentations, or forgeries in this application, and CVST makes no guarantee that the information in this application is accurate or complete.