Recertification Application - Victim Service Practitioner Certification
Please fill out the information below. Re-certification as a victim service practitioner is dependent upon the applicant having a criminal background check free of violent crimes or causing deaths related to alcohol or opioids, except under certain conditions. NCVAN reserves the right to request criminal background checks to demonstrate this necessary condition has been met. Released from this requirement are applicants currently employed by law enforcement organizations, district attorney offices, and community based non-profits recognized by the NC Council for Women as a designated providers of services to victims of violence. Staff from these types of organizations are not required to submit a criminal background check since those checks have already been conducted by their places of work. All other applicants may be asked to obtain such a check or provide a copy of a recent check in order to be considered for certification. Should it be determined that such a background check is necessary, NCVAN will contact the applicant before proceeding.
Formal Name (Name you would like to appear on the Certification)
*
First Name
Last Name
Preferred Email Address
*
example@example.com
Preferred Pronouns
Optional
Preferred Work Phone Number
*
This is the best number for other professionals to reach you.
Preferred Cell Phone Number
*
This is the best number for NCVAN staff to reach you during the Academy for important updates.
Agency or Organization
*
Field of Work (Check All That Apply)
*
Non-Profit Community Based Domestic Violence/Sexual Assault Advocate
Children's Advocacy Center Advocate
Prosecutor
Court or District Attorney Staff
State Government Agency
Homicide Support Advocate
Human Trafficking Advocate
Culturally Specific Advocate
Law Enforcement Based Advocate
Law Enforcement (Sworn)
Law Enforcement (Unsworn)
Military/National Guard
Social Worker
Licensed Therapist
Medical Professional
University/College
Clergy
Other
Position Title
*
County of Employment/Volunteering
*
Preferred Mailing Address to Receive New Certification
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
If I receive my NCVAN Recertification, I give permission for my name to be included in a list of currently certified NCVAN Victim Service Practitioners on NCVAN's website, visible to the public, including interested potential employers and other service providers. (Only your name will be visible to the public.) NOTE: This listing is in cultivation and not yet available).
*
Yes
No
If I receive my NCVAN Academy Recertification, I give permission for NCVAN to include my name and contact information in a password-protected directory of currently certified NCVAN Victim Service Practitioners for peer networking purposes (NOTE: This directory is in cultivation and not yet available).
*
Yes
No
Have you completed a minimum of 20 continuing education training hours of direct victim services with a state direct victim services agency?
*
Yes
No
Back
Next
Please Upload Your Training Log Reflecting 20+ Hours of Continued Education in Victim Services - Please make sure to include the training hours, training topic, date of completion and organization/agency that hosted the event:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please scan and upload copies of certificates of attendance/completion from trainings:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your expiring certification:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
When was your last certification or recertification granted?
*
Please Select
Spring 2020
Fall 2020
Spring 2021
Fall 2021
Spring 2022
Fall 2022
Spring 2023
Fall 2023
Spring 2024
Other
Back
Next
prev
next
( X )
NCVAN Victim Service Practitioner Recertification Fee
$
125.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
TO PAY BY CHECK, PLEASE CONTACT US AT TRAINING@NC-VAN.ORG TO RECEIVE YOUR CODE TO BYPASS PAYMENT.
Submit
Should be Empty: