[2019 Revision] National Referral Directory Application 

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National Referral Directory Application

The National Human Trafficking Hotline's National Referral Directory is comprised of service providers, government organizations, task forces, coalitions, and other organizations that are working to combat human trafficking through victim services or other indirect services available to the trafficking field. 

To ensure the National Hotline can meet its goal of providing up-to-date and high quality referrals to meet survivors' unique needs in a given area, the National Hotline reviews and vets every application prior to adding new organizations to the National Referral Directory. Organizations interested in being included in the database are asked to complete the following form. Only authorized staff members from the organization should complete this form. Organizations that already exist in the National Referral Directory will be asked to complete an annual update process, reviewing and updating all fields on this form to ensure accuracy as well as to fill in newly added information aimed to improve the referral process for survivors. 

Once the form has been submitted, National Hotline staff may follow-up with you via email or a phone call to discuss your agency's structure, service delivery policies and procedures, and available services, and to develop specific referral protocols. The National Hotline may also request a letter of support to verify the organization’s experience working directly with survivors of human trafficking and/or other at-risk or related populations, as well as to confirm that the organization is in good standing within its field. You can expect to receive a response regarding your application within 4-6 weeks of submission, though response time may vary depending on volume of annual updates and new applications. 

The National Hotline does not endorse or certify organizations included in our database. Your answers to the questions listed below will help us to determine if your agency meets the minimum National Hotline criteria for inclusion, and to ensure that you are receiving the appropriate referrals based on your mission, capacity, and service area. For more information about the database, policies, and inclusion criteria, click on the following link.
It is recommended that you create a login in order to save your progress and resume later. 
 
If your organization has the following documents, you will be asked to upload them for the Hotline's vetting records:
  • Official Confidentiality Policy
  • Non-Discrimination Policy
  • Housing License
  • Non-Profit Status documentation (if current documentation is not available on Guidestar)
  • Screening Form (optional)
By completing this form, you affirming that you are a staff member of the organization applying to be included and are authorized to provide information on behalf of your organization. It is recommended that only a staff member who would be the designated Referral Directory primary point of contact for communication with the Service Provider Partnerships team complete this form. 
Referral Directory Point of Contact
Information in this section will be accessible by Hotline staff only and may be shared as needed with the organization applying to be included in the Directory for verification purposes. It will not be posted publicly unless also annotated as public contact method in the referral information section
 
Information about Person Completing This Form








Staff Point of Contact
The staff point of contact is a designated staff member who the National Hotline Partnership team should reach out to for any future updates to your organization's record.






(###) ###-####

(###) ###-####


Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org.
Organization Overview
The information gathered in this section may be shared with people who reach out to the Hotline or posted publicly if your organization opts for the online, public version of the Directory.








If you are a social services or legal services provider, choose "Direct Services Provider." If you are a community group, advocacy group, or non-government agency that does not provide social or legal services, choose "Indirect Services Only." If your organization is an Indirect Service Provider, the type of referral services would be restricted to: Education/Job Training, Interpretation/Translation, Outreach/Awareness, Survivor Leadership, Training, Transportation Assistance, or Volunteer Opportunities.

This number may be shared with stakeholders for vetting or informational purposes

Include Hours of Operation, Purpose of Line (administration, training requests, etc)









Please enter any additional information about your language capacity that may be useful those using our Directory to know
SPECIALIZATIONS
This section will help determine how your organization should be displayed in the National Referral Directory, as well as to help survivors identify organizations that specialize in their experiences. The information in this section will be shared with those reaching out to the hotline and may be displayed publicly if your organization opts to be displayed in the public version of the Directory.  


Specialization in Serving Vulnerable Populations
Please only select the following specializations when it is part of your organization’s core mission/focus to serve these groups, resulting in particular expertise. It is assumed that agencies that do not “specialize” in serving these populations will still offer services to clients who identify with these populations and meet agency intake criteria. 

Select all "specializations" that apply:
Organization Details
Information in this section will be used during the review process to determine if your organization meets the minimum inclusion criteria for the National Referral Directory as well as to build context around how your organization provides services. The information provided here will be used for internal vetting purposes and will only be shared with those involved in the vetting process, which may include external stakeholders. 





If yes, please upload file on last page

If yes, please upload file on last page




 
 
Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org.
REFERRAL METHODS
This section contains the critical information needed to make referrals smoothly, in the quickest way possible. We recognize that sometimes the best referral method, especially for after hours emergencies, is a private phone number. Please carefully note at the bottom of the page which contact methods are public and available to share with people who reach out to the Hotline

If your organization offers crisis services or emergency shelter as part of your referral services, please provide a 24 hr number that the National Hotline can use to access those services after hours. Please annotate those that are 24/7 at the bottom, and make note of any specific hours or days the contact information is available in the details for each contact method


Referral Contact Information

(XXX) XXX-XXX

Include Hours of Operation, Purpose of Line (i.e., Shelter Number)

(XXX) XXX-XXX

Include Hours of Operation, Purpose of Line (i.e., Shelter Number)

(XXX) XXX-XXX

Include Hours of Operation, Purpose of Line (i.e., Shelter Number)

(XXX) XXX-XXX

Include Hours of Operation, Purpose of Line (i.e., Shelter Number)

The Primary Email may be listed publicly or shared for referral or vetting purposes

 
 

Contact methods that are made publicly available will be posted on the website (if you chose to be public) and/or given to callers who reach out to the Hotline. Contact methods not marked here will remain private for use by Hotline Advocates directly connecting callers to your organization for referrals.

Only select contact methods that will result in an immediate response if the Hotline contacts at any time of day. If the contact method is not 24/7, then please annotate the hours of operation in the notes above 





INTAKE PROCESS







These sections will help the Hotline and those seeking services determine if the referral is a good fit. 
Geographic Service Area


Eligibility and Program Requirements
Eligibility Requirements
Choose all that apply from each demographic section. Please select all demographic options that are considered eligible for your services. At least one selection from each section must be made. 
Eligible Demographics*

If populations you serve for any services are under 18, please select "Minor"
If populations you serve are 18 and over, please select "Adult."









Program Requirements




Additional Accessibility Information 


Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org.
Services for Victims of Trafficking
 



Do not select if you only provide long-term care through an MOU with another organization.

SERVICES OFFERED
Please select all of the services you offer directly or through a stable MOU. Due to the purpose of our Referral Directory, it will be assumed that all services listed will be available to survivors and victims of human trafficking.

Notes are required for each service, as they are very helpful for our Hotline Advocates when making referrals and provides viewers of our public Referral Directory with some context. Also be careful to select the populations that are eligible for each service (including selections from each category: age, gender, type of trafficking; and nationality). 

If you select Emergency Shelter or Crisis Services, you must either provide a 24 hour hotline in Section 1 of this form or have a crisis referral protocol in place with the National Hotline. If the latter, please state in your note "to access emergency services, call the National Hotline for a referral."
Organization provides addiction treatment in-house or via MOU. Organization can serve a client with an addiction who has not received prior treatment.



Needs assessment and assistance acquiring services and benefits whether in-house, through partner agencies, or public services.



Organization offers child care for dependents of clients on-site or via MOU with a child care agency.



24 hour access to an advocate for assistance locating shelter, speaking to law enforcement, or accessing other needed assistance.



Organization has a location where survivors of trafficking can stop by without an appointment or rest, advice, or other assistance.



organization provides education and job training such as ESL, Computer Classes, or job placement services, in-house or via MOU.



Program offers 24-hour access to accommodations in-house or via MOU



Organization can assist client in locating family members and reuniting family in the US.



Organization provides health-care on-site, operates a clinic, or has an MOU with a health-care provider.



Organization can provide qualified interpreters for court proceedings, for law enforcement, or for other agencies. DO NOT select if interpretation/translation services are limited for use within your agency and not as described above. 



Legal Assistance/consultation for civil legal matters provided by attorney.



Legal Assistance/Consultation related to criminal defense or crime victim rights advocacy, provided by a licensed legal professional.



Definition: Legal Assistance/consultation provide by an attorney or BIA accredited representative.



Residential housing for more than a year.






Organization can assist client in returning to country of origin.
Repatriation details






Supportive counseling not provided by a licensed therapist.



Organization has a policy or program to support professional development, leadership training, and/or employment to survivors of human trafficking.



Residential housing for a period of 1 month up to 2 years.



Organization can provide or fund transportation locally and/or nationally. If you provide transportation on a case-by-case basis but do not wish this to be publicly known, please contact the NHTH hotline.



Additional Shelter Details
If your organization provides overnight shelter or housing to clients, please complete the following questions.



Please upload copy of housing license on final page if able.





Resources and Opportunities in the Anti-Trafficking Community
Select each of the services you offer related to the anti-trafficking community. 
Organization conducts outreach or raises awareness on topics related to human trafficking.


Available to conduct trainings and presentations related to human trafficking.


Volunteer opportunities for community members wanting to get involved in the anti-trafficking field.





Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org.
Questions regarding anything in this form? Visit this document or email the National Hotline at help@humantraffickinghotline.org.


Only files ending in .doc, .docx, .pdf, .odt, .pages, or an image file.

Only files ending in .doc, .docx, .pdf, .odt, .pages, or an image file.

Only files ending in .doc, .docx, .pdf, .odt, .pages, or an image file.

Only files ending in .doc, .docx, .pdf, .odt, .pages, or an image file.