Home
Related Media Articles
Targeted Artists & Authors
In Memoriam
NEW MEMBER APPLICATION (USA Only)
Memberships are FREE, but
donations
are always appreciated. At this time, memberships are only available to United States residents.
SECTION 1: CONTACT INFORMATION
PLEASE NOTE: Memberships are not available outside of U.S.
*
Indicates required field
1-1: Name
*
First
Last
[object Object]
1-2: Email
*
1-3: Phone Number
*
1-4: ADDRESS
*
1-5: CITY
*
1-6: State (United States ONLY)
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
1-7: ZIPCODE
*
1-8: Birth Date (MM/DD/YYYY)
*
1-9: Are you a U.S. veteran?
*
Yes
No
Respond to sections of the application that you are interested in learning more about/ participating in. It is not required that you fill out each section.
SECTION 2A: LOCAL NETWORKING
Welcome to our state networking campaign!
Make sure to input your preferred contact information if you want SHSA to include you in our
state-by-state web pages
.
If interested, please complete the following fields. Name,
at least
one form of communication, and choice of sending your information to your state or
chapter
are required.
2-A1: NAME (FIRST NAME REQUIRED)
*
How do you want your name to appear in the email campaign?
2-A2: EMAIL ADDRESS
*
2-A3: PHONE NUMBER
*
2-A4: State or Chapter
*
Please send to TIs in my state.
Please send to TIs in my chapter.
SECTION 2B: INTERNATIONAL NETWORKING
People who sign up for the database have the choice of whether or not they wish to include their contact information. The purpose of the database map is to create a picture for our community to use as a guide when explaining the targeting crimes AND to give our community a communications resource outside of social media.
Name and country are required.
2-B1: NAME (FIRST NAME REQUIRED)
*
How do you want your name to appear in your listing?
2-B2: E-Mail Address
*
2-B3: Phone Number
*
2-B4: Location Preference
*
Include city, state/ province, and country
Include state/ province and country
Include country
SECTION 3A: FUTURE SHSA HOUSING APPLICATION
We are working hard to acquire funding to provide affordable housing to targeted individuals and we are also accepting applications for future housing opportunities provided by SHSA.
If interested, please complete the following fields.
Please answer all questions to the best of your ability. There is no right or wrong answer; it is possible that you will be not disqualified because of your truthful answers. All applicants caught intentionally falsifying the truth will be denied.
3-A1: What is your current monthly net income?
*
3-A2: Number of Rooms Requested
*
1
2
3
3-A3: Number of Adults Applying For
*
1
2
3-A4: Number of Children Applying For
*
0
1
2
3 or more
3-A5: Names of Adults Applying For
*
3-A6: Names of Children Applying For
*
3-A7: Do any applicants have a criminal record?
*
Yes
No
3-A7(a): If yes, please explain.
*
3-A8: Do you have any pets?
*
Yes
No
3-A8(a): Please specify breed(s) and if each animal is an indoor or outdoor pet.
*
3-A9: Do you plan to find employment or enjoy a retirement-like lifestyle?
*
Find employment
Retirement-like lifestyle
3-A10: Please list all special food/ medical preferences. (If none, type NA.)
*
3-A11: Do you require a safe in your room(s)?
*
Yes
No
3-A12: Do you smoke cigarettes, cigars, or vape?
*
Yes
No
3-A13: What are your hobbies in your spare time?
*
3-A14: Are you willing to assist with another TI community in the near-future?
*
Yes
No
3-A15: How long have you been a targeted individual?
*
3-A16: Are you interested in pursuing a lawsuit or starting a business?
*
Lawsuit
Business
Both
None of the above
3-A17: Please describe your ideal living environment.
*
3-A18: Be negative if you must. Describe your nightmare living arrangement.
*
SECTION 3B: OFFERING HOUSING
If interested, please complete the following fields to add your FREE listing to our Community Resource pages. All fields required. If you would like photos added to your listing, please email them to
[email protected]
DO NOT FILL THIS SECTION OUT IF YOU ARE NOT OFFERING A PLACE TO STAY
.
3-B1: Property Location (State Required)
*
3-B2: Listing Options
*
Temporary Housing
Permanent Housing
Bedroom Offered
Couch Offered/ Not Offering Bedroom
No Smoking
Drug & Alcohol Free
Background Check Required
Must Have Income
Must Have Vehicle
Males Only
Females Only
No Pets
Pets Allowed
Offered to One Person
Offered to Multiple People
3-B3: Comment
*
SECTION 4A: FUTURE SHSA EMPLOYMENT APPLICATION
We intend to offer employment positions in the future and are collecting names of targeted people who may be interested in joining our team as paid employees. When an opportunity arises, we will contact you for more pertinent information.
If interested, please complete the following fields. All fields required.
4-A1: Date You Can Start
*
4-A2: Desired Industry/ Position
*
4-A3: Desired Salary
*
4-A4: Desired Location
*
4-A5: Availability
*
Full Time
Part Time
Temporary
Seasonal
4-A6: Employment History/ Skill Set
*
SECTION 4B: OFFERING EMPLOYMENT
If interested, please complete the following fields to add your FREE listing to our Community Resource pages. All fields required. If you would like photos added to your listing, please email them to
[email protected]
DO NOT FILL THIS SECTION OUT IF YOU ARE NOT OFFERING A JOB
.
4-B1: Company Name
*
4-B2: Contact Person
*
4-B3: Contact Email
*
4-B4: Position Offered
*
4-B5: Hours Offered
*
Full Time
Part Time
Temporary
Seasonal
4-B6: Pay Rate
*
4-B7: Listing Content
*
SECTION 5: TI GIVING TREE
If interested, please complete the following fields to add yourself to our TI Giving Tree page. All fields required.
5-A1: FUNDRAISING PLATFORM
*
GoFundMe, PayPal, CashApp, Patreon, Zelle, etc.
5-A2: URL/ LINK TO YOUR SITE
*
5-A3: TELL US A LITTLE ABOUT YOU
*
5-A4: I GIVE SURVEILLANCE AND HARASSMENT SURVIVORS ALLIANCE (SHSA) PERMISSION TO PUBLICLY POST THE INFORMATION WITHIN SECTION 6 (TI GIVING TREE) ONTO THEIR WEBSITE AND SOCIAL MEDIA ACCOUNTS.
*
I AGREE
SECTION 6: NEWSLETTER
6-1: Would you like to subscribe to our newsletter?
*
Please sign me up to receive newsletters and various announcements from SHSA.
Please do NOT sign me up to receive newsletters and various announcements from SHSA.
I understand that my registration form may take up to 90 days to process. I also understand the services offered are subject to change without notice . SHSA has the right to refuse service to anyone.
*
I agree
Submit
Home
Related Media Articles
Targeted Artists & Authors
In Memoriam
