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Arkansas Victims Assistance Academy

2013 Application

AVAA online application form

All fields are required. If a question does not apply to you please insert N/A or choose a BEST answer.

After you submit your application you will be directed to a confirmation page. Please print that for your records. Please DO NOT resubmit your application. For assistance contact Jennifer Miller at jmmiller@ualr.edu


Applicants name


Applicants address


Applicants city and zipcode


Applicants email address


Applicants phone info


Applicants fax info


Applicants employer


Applicants job title


Applicants county of employment


Applicants supervisor


Applicants supervisor’s contact information


Applicants length of time in their job field


Applicants emergency contact information


Applicants jurisdiction level


Applicants type of victims served


Applicants victim services provided


Applicants primary services


Why do you want to attend the AVAA?


Dorm Accommodation


Shirt Size


Disability / Food Needs

Updated 8.21.2012