(1) Each Program Participant must be
certified by the Program Manager to participate in the Program.
(2) Program Participant certification will be
granted only where the prospective Program Participant:
(a) is a current Massachusetts
resident;
(b) is a victim of
domestic violence, rape, sexual assault or stalking;
(c) provides specific evidence that the
applicant
1. is a survivor of domestic
violence, sexual assault, rape or stalking, including certified law
enforcement, court, federal and/or state agency records or files or
2. the applicant provides other specific
evidence deemed acceptable in the sole discretion of the Program Manager and
General Counsel of the Office of the Secretary of the
Commonwealth.
(d) affirms
under penalties of perjury that the disclosure of their address will threaten
the safety of the applicant or applicant's minor children or the minor or the
incapacitated person on whose behalf the application is made;
(e) completes, signs, dates and provides all
necessary information required under M.G.L. c. 9A, § 2 and the standard
application form and the authorization card form provided by the
Program;
(f) agrees in writing to
use the applicable substitute addresses designated by the Program for use by
Program Participants;
(g) agrees in
writing to abide by
950 CMR
130.00 and all other written Program rules, policies
and procedures;
(h) provides the
residential address and mailing address, if applicable, where the applicant may
be contacted by the Program Manager or their designee and the telephone
number(s) where the applicant may be called by the Program Manager or their
designee; and
(i) provides one or
more addresses the applicant requests not be disclosed for the reason that
disclosure will jeopardize the applicant's safety or increase the risk of
violence to the applicant or members of the applicant's household.
(j) demonstrates custody or guardianship of
any minor children or incapacitated persons also being admitted to the Program
and agrees not to use to use the Program to evade law enforcement or to avoid
establishing or following child custody or visitation orders.
(3) Prior to certification of the
application, the Program Manager may request additional documentation from the
Program applicant relevant to a determination of eligibility, including, but
not limited to, identification documents such as birth certificates or
passports and evidence of any relevant judicial proceeding, criminal complaint,
or proceeding brought under M.G.L. c. 209A.
(4) A properly completed application shall be
effective on the day that it is certified by the Program Manager.
(5) An individual who is certified as a
Program Participant shall be issued a Program Participant's identification card
which includes their name, identification code, substitute address,
certification expiration date, and applicant's signature.
(6) The term of a Program Participant's
certification shall be four years following the effective date of their
application certification unless the certification is withdrawn or canceled
before that date pursuant to M.G.L. c. 9A, § 3 or
950
CMR 130.09.
