Children's Administration, Department of Social and Health Services
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Certification Process

Any program wishing to provide treatment to perpetrators of domestic violence must request certification from the Department of Social and Health Services.

A program may not provide direct treatment services to domestic violence perpetrators without being certified by the department. DSHS considers each geographical location of a program an individual program, and must certify each program separately.

If approved, DSHS grants certification for a two-year period.

Get Application

The application and the Staff Statement of Qualifications forms are made available in the following ways:
  • Online
    • Application for Program Certification (form #10-209) - Word | PDF
    • Staff Statement of Qualifications (form #10-210) - Word | PDF

    These forms are also listed on the Electronic DSHS Forms page.

  • By Mail
  • To request an application by mail, write to:
    Domestic Violence Perpetrator Treatment Program
    Department of Social and Health Services (DSHS)
    Children's Administration
    P.O. Box 45710
    Olympia, WA 98504-5710

Submit Application

Your program must submit the application, an application fee of $100, and the following documentation:

  1. A written statement signed by your director that the program complies with the standards contained in Washington Administrative Code (WAC) 388-60.
  2. Results of current criminal history background checks conducted by the Washington State Patrol for all current direct treatment program staff.
  3. A statement for each current paid or volunteer staff person whether or not the staff person has ever been a party to any civil proceedings involving domestic violence.
  4. Proof that each direct treatment staff is registered as a counselor or certified as a mental health professional with the Department of Health.
  5. Evidence that your program maintains cooperative relationships with agencies providing services related to domestic violence. This evidence must include:
    1. At least three items of evidence that you have established and continue to maintain cooperative relationships with local domestic violence victim programs and other local agencies involved with domestic violence intervention.
    2. Documentation that you have established a referral process between your program and the local domestic violence victim services programs.
    3. Proof that you participate in a local domestic violence task force, intervention committee or workgroup if one exists in your community.
  6. The program may also submit evidence of the following:
    1. Participation in public awareness activities sponsored by the local domestic violence victim services agency.
    2. Service agreements between the local domestic violence victim services agency(ies) and the treatment program.
    3. Letters of support for the program from other agencies or parties involved in domestic violence intervention.
    4. Evidence that the program maintains cooperative relationships with agencies involved in domestic violence intervention.