Organisational Membership Expression of Interest 1. Type of ApplicationIf you are unsure about what category you fall into please go to our membership page on our website to read further information. Alternatively, you can give us a call on 02 9698 9777.Is this a new member expression of interest or are you renewing your current membership?* This is a new expression of interest to become a member of DVNSW I am renewing my membership to DVNSW My organisation is enquiring to be a* Full Member Associate Member I'm not sure 2. Your organisationWhat's your organisation's name?* Organisation ABN Details* What type of service do you identify as? Please tick all that apply to your organisation..* DFV Specialist Service Refuge Crisis Service Women's Support (no accommodation) Women's Service Women's and Children Service Women's Health Service Women's Legal Service Sexual Assault Service Family Support Service Safe House Generalist Homelessness Service Counselling Service Specialist Homelessness Service Peak Body Domestic Court Advocacy Service Community Housing Provider Transitional Accommodation Staying Home Leaving Violence Other If you selected other, please specify* What's your organisation's main phone number?*Organisation Website address* What is your organisation's postal address? (please include PO box address)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What area/region or local government area does your organisation predominantly work in?* NSW All Central Coast Far West NSW New England North West Newcastle and Hunter ( includes Buladelah, Broke, Cessnock, Dungog, Maitland, Nelson Bay, Newcastle, Scone and Taree) Mid North Coast ( Coffs Harbour, Bellingen, Nambucca, Kempsey and Port Macquarie) Riverina Murray ( includes Albury, Batlow, Cootamundra, Denilliquin, Griffith,Gundagai, Tumut and Wagga Wagga) Nepean/Blue Mountains Northern NSW Northern Sydney South East Sydney South West Sydney South Sydney (includes St George area and Sutherland Shire) Illawarra and South Coast Western NSW Why does your organisation wish to become a member of DVNSW?*3. Your organisation and its service deliveryWe would like to be able to know more about your organisation so that we can better advocate for our sector.Please advise the hours of operation of your organisation. This is helpful for us when we are advocating for our frontline services. Mon- Fri 9am- 5pm 24 hours, 7 days a week Monday- Saturday 9am-5pm Other If you service has different operating hours, please specify? How many clients did your organisation/agency provide service to in the last financial year? Please provide an approximate number.What percentage of your clients are children and young people ( 0-25 years) What percentage of your clients are from CALD backgrounds? What percentage of your clients identify as Aboriginal or Torres Strait Islander? What percentage of your clients have a disability? What percentage of your clients identify as LGBTQI+? 4. Contact DetailsWe need a primary and secondary contact to put on our database. We'd recommend this be the CEO and Finance Officer. We'll be in touch with you directly to add further staff onto the database to receive our communications and updates. Name (Primary Contact) First Last Position Direct LineEmail Address* Name (Secondary Contact) First Last Position Direct LineEmail Address 5. Your fundingPlease choose what category your organisation's funding falls into. *When we say funding, it means the amount of money you receive annually. Where does your organisations funding come from?* Specialist Homelessness Service (SHS) Domestic Violence Response Enhancement (DVRE) Staying Home Leaving Violence Community Legal Centres Early Intervention and Placement Prevention Intensive Family Support/Preservation DV Court Advocacy Service Brighter Futures Integrated DFV Service Families NSW Women's Health Services NSW Aboriginal Child, Youth & Family Strategy Drug and Alcohol Mental Health Aboriginal Health Out Of Home Care Private/Corporate Donors Legal Aid Government Funding (Commonwealth, NSW State etc) NGO Health Other If your selected other for funding ? Please specify details* Please choose what category your organisation circumstance falls into*Category A: $10M+ Membership Fee: $3,000 (excluding GST)Category B: $4-10m Membership fee $950 (excluding GST)Category C: $2m-4m Membership Fee $850 (excluding GST)Category D: $1.5M-2M Membership Fee $750 (excluding GST)Category E: $1-1.5m Membership Fee $500 (excluding GST)Category F: $500,000 - $1m Membership Fee $400 (excluding GST)Category G: $300,000 - $500,000 Membership Fee $300 (excluding GST)Category H: $150,000 - $300,000 Membership Fee $150 (excluding GST)Category I: $150,000 or below Membership Fee $100 (excluding GST)Category J: Aboriginal Controlled Organisation Membership Fee Free6. Communications and MarketingDo you consent to your service being listed on the DVNSW website and publications? (no physical address will be shown)* Yes No We send out regular newsletters to our members informing them of trainings, advocacy and policy changes, conferences and other information that we believe is useful to share. Do you consent to DVNSW sharing your organisations updates with our members if we receive them and we sit fit?* Yes No 7. Consents and Next StepsTo determine your organisations membership criteria, please click the most relevant to your organisations below: My organisation uses the DVNSW Good Practice Guidelines to inform our practice My organisation uses the Our Watch Change the Story framework to inform our practice My organisation knows about the DVNSW Good Practice Guidelines but we don't necessarily work with it all of the time My organisation knows about the Our Watch Change the Story Framework but we don't necessarily work with it all of the time Terms and Conditions* I agree on behalf of my organisation on the terms and conditions set out in the DVNSW constitution The information I have provided above is a true reflection of how my organisation works and practices Thank you for expressing an interest to become a DVNSW member. We will contact you shortly to get further information if required. Please have details regarding your organisation available and any staff information that you’d like to add on to your membership.