Safe at Home
Wisconsin Address Confidentiality Program
• Complete this application AFTER meeting with a Safe at Home designated Application Assistant to create a safety
plan. If you need information about how to find a designated Application Assistant, please call Safe at Home at 1-
800-446-6564 or email: Safeathome@doj.state.wi.us
• Complete your application as clearly and thoroughly as possible. The more information you provide, the better we
can protect your actual address.
1. Applicant must be a Wisconsin resident.
2. Applicant must be a victim of an act or threat of abuse, a parent or guardian of a person who is a victim of an
act or threat of abuse, or a resident of a household in which a victim of an act or threat of abuse also resides;
or the applicant must fear for his or her physical safety or for the physical safety of his or her child or ward.
“Abuse” means domestic abuse, child abuse, sexual abuse, stalking, and/or trafficking.
3. The applicant resides or will reside at a location in Wisconsin that is not known by the person who committed
the abuse against, or who threatens the applicant or his or her child or ward.
4. The applicant may not disclose his or her actual residential, work, or school address to the person who
committed the abuse against, or who threatens the applicant or his or her child or ward.
An applicant may be eligible regardless of whether any criminal charges have been brought, whether the applicant
has sought a restraining order, or whether the applicant has reported any act or threat to law enforcement.
• Section 1 should be completed by the primary adult applicant. If you are completing the application on behalf of
your child(ren) or ward(s), please put yourself as the primary applicant and list your children or wards at the end of
• All adult applicants should complete their own Safe at Home application, regardless of whether or not they reside
with other adult applicants.
• You may choose to use your Safe at Home assigned address in place of a work or school address.
• All minor children and wards residing in the home of the primary adult applicant should be listed at the end of
Section 1 to ensure that they are properly authorized to use the Safe at Home address to receive mail.
• Section 2 requests information about the DOJ designated Application Assistant with whom you worked to create
your safety plan.
• In very limited situations, state or local government agencies or law enforcement may request information about
participants. Safe at Home asks that you provide complete information about the abuser or person you fear so
that we may be diligent in protecting your information from that person.
• Section 3 is optional, but providing the information requested in this section will allow Safe at Home staff to provide
additional safety planning resources specifically tailored to your needs.
• If you plan to move shortly after submitting this application, write your new address and the date that it will be
effective on a piece of paper and submit it along with this application.