Accessibility Project Demographics and Follow Up Form
This demographics form is required for any services provided under the Accessibility Project Grant through the New Mexico Coalition Against Domestic Violence for reporting to the NM Crime Victims Reparations Commission. If you have any questions about this form, please contact janell@nmcadv.org.
Service Date
Agency
Person Requesting Services
Service Type
Victim Type
Number of Secondary Victims
Race/Ethnicity
Gender
Age
Relationship to Offender
Person has Limted English Proficiency
Person has disabilities
Person is immigrant, refugee, or asylum seeker
Person lives in a rural area
Language requested
Anything else we can share with the funder about the use of funds to support the work
  THANK YOU!!

NMCADV This project was supported by subgrant #120 2015-WF-120 awarded by the NMCVRC for the STOP Formula Grant Program. The opinions, findings, conclusions, and recommendations expressed in the program are those of the author(s) and do not necessarily reflect the views of the NMCVRC or the Department of Justice, Office on Violence Against Women.