Service Registration

Welcome to ARS!

Please fill out the organization information page once. If you have already done so, skip it and go on to the service registration step.

Step 1 of 6

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Welcome to ARS

Organization Information: Only Fill Out ONCE!

Organization Name(Required)

Organization Email

Phone Number

Street Address

Zip Code

Website URL

501c3?

Year Incorporated

What is your organization's primary purpose?

What are your organization's affiliations or licenses? (Select all that apply)

NTSA/Atlas Free Accredited Member

NTSA/Atlas Free General Member

NTSA/Atlas Free Associate Member

Freedom Network Member

Office for Victims of Crime Grantee

Office for Violence Against Women Grantee

VOCA Grantee

Licensed to provide residential care to minors

Please select the traits that best describe your organization: (Select all that apply)

Faith-Based

Harm Reduction Oriented

Indigenous-Informed

Indigenous-Led

Labor Trafficking Survivor Services

Prostitution Related Services

Sex Trafficking Survivor Services

Survival Sex Related Services

Survivor-Informed

Survivor-Led

What religion or denomination is your organization associated with, or None?

Please provide a brief overview of your organization's mission and services related to Human Trafficking (800 characters max).

Service

Fill this section out for EACH service offered. Each service involves every way a survivor can enter into your organization. For example, if you have advocacy AND long term, then that's 2 forms. If they can only access advocacy if they are in long term- that is only one form. Please contact referral@atlasfree.org if you have any questions

Service Type(Required)

Service Name(Required)

Service Email(Required)

Service Phone

Service Street Address(Required)

Service ZIP Code(Required)

Total Beds(Required)

Does this service maintain a waitlist?(Required)

When did, or will, you begin providing this service?(Required)

Is this service time limited?(Required)

Please provide a brief description of this service(Required)

Demographics

What genders do you serve? (select all that apply)(Required)

Female

Male

Non-binary

Transgender

Two-Spirit

What demographics do you serve? (select all that apply)(Required)

Single individuals

Pregnant individuals

Parenting individuals

Married couples

Parenting couples

How many dependents do you accept?

What is the age range of dependents?

What is the minimum age you serve?(Required)

What is the maximum age you serve?(Required)

Eligibility

What are your citizenship requirements? (select all that apply)(Required)

Accept U.S. citizens

Accept documented foreign nationals

Accept undocumented foreign nationals

Do you accept clients with: (select all that apply)

Limited English speaking ability

No English speaking ability

Do you accept clients from out-of-state who need to relocate?(Required)

This service is available for those who have experienced: (select all that apply)(Required)

Sex trafficking

Labor trafficking

Prostitution

Survival sex

Other forms of commercial sex

This service is available for those who: (select all that apply)(Required)

Have an abuser actively looking for them

Have outstanding warrants or legal obligations

Are involved in open or pending investigations or cases

Are currently incarcerated

Were recently incarcerated

Will be on parole or probation

Have a history of criminal charges

Are part of a diversion program with court requirements

Are registered sex offenders

This service is available for those who: (select all that apply)

Have immediate health concerns

Have physical disabilities

Have a certified service animal

Have an emotional support animal

Have reported self-injuring

Have reported suicide ideation

Are currently taking prescribed medication for mental illness

Experience episodes of psychosis

Have used illegal substances in the last 7 days

Use marijuana (where legal)

Service Model

Which options describe your service model? (select all that apply)(Required)

Person-centered / Individualized

Program-centered / Curriculum based

Trauma-informed

Evidence-based

Strengths-based

Survivor-led

Survivor-informed

Faith-based

Clean and sober

Harm reduction

Recovery-focused

Which options describe your team's diversity for this service? (select all that apply)

Bilingual or Multilingual

Black, Indiginous, or Person(s) of Color

Gender and sexual minorities

Lived experience of the sex trade

People with disabilities

Religious minorities

Survivor of human trafficking

Select the faith engagement approach for this service:(Required)

Please describe faith engagement practices for this service:(Required)

Which option best describes this service's structure?(Required)

Which option best describes this service's sleeping arrangement?(Required)

Which option best describes the service's staffing level?(Required)

Do any of the following guidelines apply for this service? (select all that apply)

No unapproved visitors

Initial blackout period (no phone, no internet, etc.)

Daily curfew (must be in by a certain time each night)

What, if any, requirements must be met for someone to enter this service? (select all that apply)

Verified as a victim/survivor of human trafficking

Must be clean/sober for a certain number of days

Must have a clean U/A

How many days clean/sober?(Required)

What support do you provide within this service? (select all that apply)(Required)

Case management

Education

Employment preparation

Employment placement

Equine or animal therapy

Financial assistance

Food/groceries

Goal planning

Housing advocacy or navigation

Hygiene supplies

Immigration support

Information and referral

Life coaching

Life skills

Medical consultation

Medical service

Mental health counseling or trauma therapy (licensed)

Substance-use service (licensed)

Mentorship

Personal advocacy

Personal identification & documentation support

Support groups

What support do you provide through referrals to outside providers? (select all that apply)(Required)