This form should be submitted only by program participants who no longer wish to participate in the Safe at Home Program. Remember that your withdrawal request must be properly signed and notarized in order to be processed.

UCC forms are available online on our Business Forms & Fee page.

Use this form to request that the Secretary of State verify your eligibility, and the eligibility of your children, for enrollment in public benefits programs or public schools. Participants should fill in their information and take this form to the public benefits agency or public school to be completed by a case manager or registrar. The form should then be submitted directly to the Safe at Home Program for verification and certification. Participants must ensure that their residential address is up to date and that the Safe at Home Program has fully verified their residential address prior to submitting the form.

se this form to let the Safe at Home Program know about any changes in your contact information, your household composition, and more. If you have any questions about this form, please contact the Safe at Home program directly for assistance. Remember that any changes to your contact information or your application information should be reported to the Safe at Home Program within 30 days from the date the change occurred.

This form is intended for use only by authorized administrative agency officials at either the state or local level. If you have questions regarding this form, please contact the Safe at Home Program directly.

Use this form to let the Safe at Home Program know that you have legally changed your name. Be sure to attach documentation of the change to your submitted form. Remember that a legal change of your name must be reported to the Safe at Home Program within 10 days of the change.

This form is intended for use only by authorized law enforcement officials to request disclosure of information pertaining to a program participant. If you have questions regarding this form, please contact the Safe at Home Program directly.

Download the READS Collection Development Policy

Download the READS Reconsideration of Materials Form

Use this form to request a contested case hearing. Participants may request a contested case hearing if they have been notified that their program participation is to be terminated, with limited exceptions, or when they have been notified that their confidential information has been requested by an administrative agency and the Secretary of State has determined that some or all of their information should be disclosed. If you think that you may want to request a contested case hearing, please contact the Safe at Home Program directly to discuss your concerns.

Use this form to request that the Safe at Home Program facilitate the transfer of records from one public school to another. Safe at Home is also happy to facilitate the transfer of records to or from a private school to another school, public or private.

This form should be used only by victims services professionals and other advocates who wish to be trained and certified as an Application Assistant. Please contact the Safe at Home Program directly for more information regarding upcoming training sessions or to schedule a training in your area.

A complaint form may be filed with the State Coordinator of Elections office or with the local county election office.

Yes, the initial registration and renewal forms shall be signed by two (2) authorized officers of the charitable organization, one of whom shall be the chief fiscal officer