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About This Application

Thank you for your interest in becoming a contributing user in the Prevention Connection Wiki Project. The Prevention Connection Wiki is a moderated forum to share insights and experiences on the prevention of violence against women, based on knowledge from practice, theory, research and evaluation of violence against women prevention efforts.

To encourage the development of a Wiki that provides thoughtful and informed information, user accounts on our Wiki are restricted. User accounts are intended for people who are dedicated to the prevention of sexual violence or violence against women. Only people with experience in violence against women prevention will be able to contribute to the Wiki. This may include (but is not limited to) prevention educators, victim advocates, researchers, public health workers, counselors, therapists, offender treatment providers, and law enforcement.

To apply for a user account, please fill-out the form below. Instructions to submit this form are at the end of the document. All applications will be carefully considered, and applicants will be informed of the status of their application within three business days. If you have questions about this application or the application process, please call Chad Sniffen at (916) 446-2520 x315 or e-mail info@.

Organization and Mailing Address

Please provide your professional, verifiable contact information.

|Full Name |      |

|Including Any Title or Suffix You Use | |

|Last Name |      |

|For Indexing Purposes | |

|Job Title |      |

|Department |      |

|Organization |      |

|Street Address or PO Box |      |

|City |      |

|State (or Country if Outside USA) |      |

|ZIP or Postal Code |      |

|Telephone |      |

E-mail Address

If you use personal contact information or free email accounts (i.e. @, @, @) please include the reasons for using the account. Typically the use such accounts is discouraged and may result in the rejection of your application.

|Email Address |      |

|Email Address Confirm |      |

|Reason for Using Personal Address |      |

|If Requested | |

Contact Permission

The contact information you provide will be used for verification purpose only, unless you indicate here that we may use your e-mail address for other purposes.

| |Yes |No |

|Add my e-mail address to the Prevention Connection Wiki Users Newsletter (1 message every 1 to 2 months). | | |

|Add my e-mail address to the general Prevention Connection Newsletter (1 message every 1 to 2 months). | | |

|Add my e-mail address to the Prevent-Connect Yahoo! Group (4 to 8 messages per day). | | |

Prevention Experience

Please describe your experience relative to the prevention of violence against women, including sexual assault and domestic violence.

     

Wiki Experience

Please indicate your level of agreement with the following statements.

| |Disagree |Disagree |Maybe |Agree |Agree |Don’t |

| |Totally |Somewhat | |Somewhat |Totally |Know |

|I can easily find information on Wikipedia. | | | | | | |

|I know how to edit a Wikipedia article. | | | | | | |

|I know how to start a new Wikipedia article. | | | | | | |

|I know how to link different Wikipedia articles together. | | | | | | |

|I know how to make a Wikipedia article look exactly the way I | | | | | | |

|want it to. | | | | | | |

|I am familiar with wikis other than Wikipedia. | | | | | | |

|I have used many different types of wikis. | | | | | | |

|I can tell when a wiki is using the same software (MediaWiki) | | | | | | |

|that Wikipedia uses. | | | | | | |

User Account Information

Wiki contributors may not author content anonymously. Your User Name will be associated with any edits that you make in our Wiki. We prefer that your User Name be some combination of your first and last name (i.e. JaneDoe, JaneD, or JDoe).

|User Name Requested |      |

|Alternate #1 If Request Not Available |      |

|Alternate #2 If Request Not Available |      |

Every User Account is automatically linked to a "User Page" that is initially blank. These user pages are visible to anyone on the world wide web. These options define what initial information you would like us to put on that page, if any. You can add, edit, or remove all of the information on your own User Page at any time.

| |Yes |No |

|Publish Name on User Page | | |

|Publish Title & Organization on User Page | | |

|Publish Address on User Page | | |

|Publish Telephone on User Page | | |

|Publish E-mail Address on User Page | | |

Is there anything else you would like us to know about you or your application?

     

Thank you for you interest in the Prevention Connection Wiki Project. You can submit this application in the following ways:

1. Save this document (as a Word file) or print it as a PDF or a Microsoft Document Image file. Then e-mail that file to info@.

2. Print and FAX it to (916) 446-8166 with attention to Chad Sniffen.

You will be contacted concerning the status of your application within three business days. If approved, your Wiki Project account will be established and your login information will be sent to your e-mail address along with a randomized password, which you are free to change.

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