CTCAHT Partnership Information Form

First name*

Last name*

Job Title

Email*

Phone number

Agency/Organization Affiliation*

Agency Website

Geographic Area the Agency/Organization Serves

Agency/Organization Description

Please provide a 75-word maximum description of your organization we can share on the Central Texas Coalition Against Human Trafficking website.

What organizational information would you prefer to keep private?

Any information not checked will be listed on the website and made available to the coalition.

Organization Name

Organization Website

Contact Email

Guidelines for Participating in the Central Texas Coalition Against Human Trafficking:

 Support the mission of the CTCAHT: “To work collaboratively to increase public awareness
and identification of human trafficking cases while providing comprehensive medical and
social services for victims and survivors of trafficking.”

 Actively attend a working group, committee or general body meetings of the Coalition (as
relevant to your involvement), and communicate reasons for prolonged periods when you are
not able to participate.

 Your involvement in the Coalition is not an endorsement of your agency/organization or any
programs related to your agency/organization by the Coalition.

 You agree not to speak on behalf of the Coalition or attempt to represent or otherwise commit
the Coalition, or any other Coalition participants, when speaking to the media, at events or in
any other setting unless otherwise approved by the Steering Committee.

 As a participant, you agree to the CTCAHT policy regarding confidentiality:

o By submitting this information form to participate in the Coalition, your agency agrees
to maintain strict confidentiality of any sensitive information shared during regular
meetings, working group meeting and committee meetings.* Violation of this
agreement may be cause for immediate termination of your involvement in the
Coalition. Guests must also agree to abide by the CTCAHT policy regarding
confidentiality.

o *Sensitive information includes details regarding human trafficking victims, survivors,
or the activities of law enforcement or social service agencies engaged in
interventions and restoration.

By submitting this information form to participate in the Central Texas Coalition Against
Human Trafficking, you and your agency/organization agrees to these guidelines.
The Steering Committee can limit or remove your participation if you and your
agency/organization do not uphold these guidelines.