Resource

Break The Chain Campaign would like to include your organization in the list of resources available to migrant domestic workers.

ORGANIZATION: __________________________

CONTACT PERSON(S): _____________________

Please describe the particular services your organization provides:

___________________________________________

___________________________________________

___________________________________________

Please check the following services you can provide to trafficked persons and/or domestic workers (check all that apply):

___ Temporary Shelter
___ Medical Care
___ Mental Health Services
___ Legal Services/Immigration
___ Food
___ Clothing
___ Employment Counseling
___ Human Rights and Workers’ Rights Education
___ Abused Victims Assistance/Domestic Violence
___ Language Services – Translation, Interpretation and ESL Training
___ Culturally Sensitive Support for ____________________________
(list country or language).
___ Other________________________

Languages you offer your services in: ______________

ADDRESS:

PHONE: FAX:

E-MAIL ADDRESS:

WEBSITE ADDRESS:

Would you like your website to be linked to the BTCC website?

Please fax (202) 387-7915 or mail this form to:
Post Office Box 34123, Washington, DC 20043