Application Forms
Batterers’ Intervention Program Application
Form A- Code of Ethics
Form B- Provider Application
Form C- Provider Advancement Application
Ethics Public Notice
Reporting Forms
Monitor Report Form
Monitoring Report Submission Form
CEU Submission Form
Renewal/Recertification
Renewal Application
Recertification Application
Batterers’ Intervention Program Dues
BIP Dues Form
Miscellaneous
Ethics Complaint Protocol
Ethics Complaint Form
Technical Assistance
Frequently Asked Questions
Contact Jessica Marcum, ICADV Program Coordinator at 317-917-3685
jmarcum@icadvinc.org
Please complete and mail all forms with your payment to:
Indiana Coalition Against Domestic Violence
1915 W. 18th Street, Suite B
Indianapolis, IN 46202
Help us to continue working toward the elimination of domestic violence. 
Help us to continue working toward the elimination of domestic violence. 
