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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

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