Providing Application Assistance
Once the applicant understands his or her role as a participant, the policies he or she must adhere to, and the benefits that are available through the Safe at Home program, the Enrolling Agency Assistant helps the applicant complete the application process. The Enrolling Agency Assistant provides in-person assistance to the applicant with completing the application materials; witnesses and signs the materials, forwards the application materials to Safe at Home; and provides follow-up assistance with incomplete or rejected applications.
- In order to eligible for enrollment in the Safe at Home program, the applicant must:
- be domiciled in California;
- be a victim of domestic violence, stalking or sexual assault or be applying on behalf of a minor child or incapacitated person who is a victim of domestic violence, stalking or sexual assault;
- attest in a sworn statement, signed under penalty of perjury that he or she (or the minor or incapacitated person for whom he or she is applying) is a survivor of domestic violence, stalking or sexual assault and that he or she is in fear for his or her safety;
- complete and sign the Application Form;
- agree to follow the program rules by completing and signing the Application Acknowledgement Form; and
- if he or she has a minor child or children, provide the name(s) and last known address(es) of the minor child or children, the name(s) and last known address(es) of the other parent(s) of the minor child or children, a copy of any court orders related to the custody, visitation or support of the minor child or children, and the name(s) and address(es) of legal counsel in those cases.
- To enroll a minor child or children, the applicant must have physical custody of the child or children and must complete an application form and ID card sheet for each child.
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Completing and Submitting the Safe at Home Application Packet
- Application process: (per Government Code §6206)
- Interested and qualified persons may apply for Safe at Home through a certified enrolling agency, only.
- The enrolling agency staff sends completed and signed materials to Safe at Home.
- Safe at Home reviews the materials to make a determination to accept or deny the application.
- The Safe at Home enrollment application review process takes approximately two weeks.
- First Step: Verify eligibility.
- Ensure the applicant is domiciled in California.
- Ensure the applicant provides a sworn statement, signed under penalty of perjury, that he or she (or the minor or incapacitated person for whom he or she is applying) is a victim of domestic violence, stalking or sexual assault and that he or she is in fear for his or her safety or for the safety of the minor or incapacitated person for whom he or she is applying.
- Ensure the applicant provides the names and addresses of any minor children, the names and addresses of the other parents of those children, the names and addresses of legal counsel in those cases and any court orders related to the custody, visitation or support of those children.
- Second Step: Help applicant complete enrollment forms.
- Brochure: Provide brochure and give general information about the Safe at Home program.
- Application Form(s): Help applicant complete one application form per person (including children).
- Acknowledgement Form: Help applicant complete one acknowledgement form (one per family or one for each adult).
- ID card(s): Applicant must complete one ID card sheet per person (two ID cards per person, parents provide parent signature on minor child ID cards). Please do not cut or perforate the ID card sheets!
- Voter Registration card: Help applicant complete a Safe at Home confidential voter registration card (if the applicant is otherwise eligible to vote).
- Third Step: Ensure all forms are included and completed correctly.
- All sections of the application and application acknowledgement form must be completed.
- Applicant and enrolling agency staff signatures must be provided in required areas.
- The sworn statement and child custody documentation and information must be included.
- Safe at Home ID cards are signed by the adult or parent.
- Things to Avoid:
- Do not make copies of materials (Safe at Home only accepts originals).
- Do not give applications to enrollees to take home.
- Do not guarantee participation in program.
- Do not punch out, cut in half, or write on the ID cards.
- Do not forget to sign as the enrolling agency assistant as required on both the application and acknowledgement forms.
- Sworn Statement Requirement (per Government Code §6206(a)(1)):
- Applicants must submit a sworn statement, signed under penalty of perjury, that he or she (or the minor or incapacitated person for whom he or she is applying) is a victim of domestic violence, stalking or sexual assault and that he or she is in fear for his or her safety or for the safety of the minor or incapacitated person for whom he or she is applying.
- Applicants may also submit (per Government Code §6206(a)(2)):
- a police report;
- a restraining order;
- a police, court or government agency record or file;
- a letter from victim advocate with substantial knowledge of abuse/harassment/threats (on agency letterhead and signed);
- documentation from a legal, clerical, medical or other professional (on letterhead and signed); or
- any other documenation that supports the sworn statement on the application.
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Rejected Application Assistance
- If there are any problems with a Safe at Home application package, including evidence or child custody discrepancies or missing or incomplete information on the application or acknowledgement form; Safe at Home will send a rejection form letter and the incomplete or new materials to either the Enrolling Agency or the applicant (depending on whether or not there is a need for Enrolling Agency assistance or clarification).
- Safe at Home staff retains the remaining rejected application materials until the new or corrected documentation is received.
- When corrected or new materials are received, Safe at Home reevaluates the application package to make sure it is complete before it is processed.
- Periodically, Safe at Home staff will contact the Enrolling Agency application assistant or applicant to check on the status of a rejected application. If there is no contact after 90 days, the applicant may be required to re-apply to the program.
- If, after one year, we have received no response to inquiries about the rejected materials by either the enrolling agency or the applicant, the application package will be destroyed. Once the application package has been destroyed, the applicant must re-apply to the program by completing new paperwork.
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