Oklahoma Coalition Against Domestic Violence and Sexual Assault
3815 North Santa Fe, Suite 124, Oklahoma City, OK 73118
405/302-0572 www.ocadvsa.org
APPLICATION FOR OCADVSA PARTNER PROGRAM
Level of Partnership being applied for:
 Purple and Teal: Individual  Purple and Teal: Organization
 Silver Partner
 Gold Partner
 Platinum Partner
Name:______________________________________________________________________
Address:____________________________________________________________________
_________________________________________________County______________________
Phone:______________________Fax:___________________Email______________________
Please check your preferred method of communication:  Phone  Fax  E-mail
If individual, what is your profession?______________________________________________
If organization or agency, what is your primary function?_______________________________
Why are you interested in becoming an OCADVSA Partner?
__________________________________________________________________________________________
__________________________________________________________________________________________
Which benefit is most appealing to you?_________________________________________________________
OCADVSA Principles of Unity
We are committed to helping people acquire the information and survival skills necessary to take control over their lives and the
decision affecting their lives; and will not encourage anyone to remain in, or return to, violent or dangerous situations. We support
and involve victims and/or survivors of interpersonal violence of all racial, social, ethnic, religious, economic and age groups and lifestyles; oppose the use of violence and sexual assault, and support equality in relation-ships and the concept of helping all people to
assume power over their own lives; strive toward becoming independent, community-based groups in which victims and/or survivors
of interpersonal violence have input into major policy and program decisions; will participate in the ongoing work of the Coalition and
will be accountable to the entire Coalition for work done by or about the Coalition on its behalf. We are committed to providing
statewide services through cooperative, collaborative and non-competitive means. We are committed to providing consultation and
education to government and private social service, criminal justice, health, welfare and other agencies.
Limits of OCADVSA Partner Program
I acknowledge that participation in the OCADVSA Partner Program does not represent any endorsement of me or the organization I
represent. I understand that making any reference to participation in the Partner Program that might indicate an endorsement,
especially in an application for funding, is a violation of the Partner Program and that all benefits association with the Partner Program
will be suspended immediately without refund.
I agree to abide by the OCADVSA Principles of Unity and the Limits of the OCADVSA Partner Program:
Signature____________________________________________________Date:______________
Partner Program Dues Year
 Enclosed are annual Partner Program dues in the amount of $__________. The Partner Program
membership year begins with the date of acceptance.
Office use only: Date of Acceptance:_______________ Approved by:____________________
OCADVSA PARTNER PROGRAM
The Partner Program of the Oklahoma Coalition Against Domestic Violence and Sexual Assault (OCADVSA)
was established to provide individuals and groups with a process through which they can make a cash donation to
demonstrate their support of the mission of OCADVSA. Participation in the Partner Program does not represent any
endorsement of the individuals or organizations that participate, but does make the individual or organization eligible for
certain benefits as outlined below.
Partner Benefits
Attend OCADVSA sponsored workshops and/or conferences at reduced registration.
Apply for OCADVSA offered scholarships.
Networking opportunities with domestic violence sexual assault service providers.
Access to OCADVSA Lending Library.
Access to the most current and up-to-date information in the nation.
Recognition of support within OCADVSA materials, website, etc.
Receive electronic OCADVSA newsletters, training and conference announcements.
Receive information on pending legislation and legislative updates during session.
LEVEL
Purple and Teal Partner: Individual
Purple and Teal Partner: Organization
Silver Partner
Gold Partner
Platinum Partner
NUMBER OF INDIVIDUALS BENEFITTING
One
Three
Six
Eighteen
Forty
SUPPORT
$50
$100
$250
$500
$1000+
Application Process:
1. Complete and sign the Application Form which include an affirmation of the Coalition Principles of Unity and
acknowledgement of the Limits of Partner Program. Provide a complete list of individuals who will utilize benefits.
2. The applicant will be required to affirm the OCADVSA Principles of Unity.
3. The applicant will be required to acknowledge the Limits of Partner Program.
2. Submit Application Form with a check payable to: OCADVSA
3. The application will be reviewed by the OCADVSA Executive Director and submitted to members of the Executive
Committee for informal review and comment period of two weeks. The Steering Committee Chairperson may request a
more formal review in the event of concerns.
4. The applicant will be notified of acceptance.
OCADVSA Principles of Unity
OCADVSA is committed to helping people acquire the information and survival skills necessary to take control over their
lives and the decision affecting their lives; and will not encourage anyone to remain in, or return to, violent or dangerous
situations. We support and involve victims and/or survivors of interpersonal violence of all racial, social, ethnic,
religious, economic and age groups and life-styles; oppose the use of violence and sexual assault, and support equality in
relation-ships and the concept of helping all people to assume power over their own lives; strive toward becoming
independent, community-based groups in which victims and/or survivors of interpersonal violence have input into major
policy and program decisions; will participate in the ongoing work of the Coalition and will be accountable to the entire
Coalition for work done by or about the Coalition on its behalf. We are committed to providing statewide services through
cooperative, collaborative and non-competitive means. We are committed to providing consultation and education to
government and private social service, criminal justice, health, welfare and other agencies.
Limits of Partner Program
The applicant acknowledge that participation in the Partner Program does not represent an endorsement of Individual or
Organizational Partners. I understand that making any reference to participation in the partnership program that might
indicate an endorsement, especially in an application for funding, is a violation of the Partner Program and that all benefits
associated with the Partner Program will be suspended immediately without refund.