Home > Victim Services Victim Services 2023 VOCA Reporting VICTIM INFORMATIONDate of Service* MM slash DD slash YYYY Was this a group or an individual?*GroupIndividualWas the individual served the actual victim or victim family?VictimVictim FamilyIndividual or Group Name Type of GroupPOMCNational Night of RemembranceHoliday Tree CeremonyMissing Persons DayVigils/Flyer DistributionOther events# of People in the Group or Event Victim Name First Last 3. Has this victim received services in the past?*Select OneYesNo4A. Race/Ethnicity for NEW Victims4a1. American Indian/Alaska Native4a2. Asian4a3. Black/African American4a4. Hispanic or Latino4a5. Native Hawaiian and Other Pacific4a6. White Non-Latino/Caucasian4a7. Some Other Race4a8. Multiple Races4a9. Unknown - NOT REPORTED by victim4a10. Unknown - NOT TRACKED by agency4B. Gender Identify for NEW victims4b1. Male4b2. Female4b3. Unknown - NOT REPORTED by victim4b4. Unknown - NOT TRACKED by agency4b5. Other (please specify below)4b6. If "Other" please describe here: 4C. Age for NEW Victims4c1. 0-1242c2. 13-174c3. 18-244c4. 25-594c5. 60 and Older4c6. Unknown - NOT REPORTED by victim4c7. Unknown - NOT TRACKED by agency5. Type of Victimization*Check all that apply.5a. Adult Physical Assault (Includes Aggravated and Simple Assault)5b. Adult Sexual Assault5c. Adults Sexually Abused/Assaulted as Children5d. Arson5e. Bullying (Verbal, Cyber or Physical)5f. Burglary5g. Child Physical Abuse or Neglect5h. Child Pornography5i. Child Sexual Abuse/Assault5j. Domestic and/or Family Violence5k. DUI/DWI Incidents5l. Elder Abuse or Neglect5m. Hate Crime: Racial/Religious/Gender/Sexual Orientation, etc.5n. Human Trafficking: Labor5o. Human Trafficking: Sex5p. Identity Theft/Fraud/Financial Crime5q. Kidnapping (Non-Custodial)5r. Kidnapping (Custodial)5s. Mass Violence (Domestic/International)5t. Other Vehicular Victimization (e.g., Hit and Run)5u. Robbery5v. Stalking/Harassment5w. Survivors of Homicide Victims5x. Teen Dating Victimization5y. Terrorism (Domestic/International)5aa. Other (describe below)5bb. If "Other" above describe here: 5cc. If "Hate Crime", please describe what type here (Racial/Religious/Gender/Sexual Orientation, etc): 6. Did this victim present with more than one type of victimization (secondary victimization)*YesNo6a. Type of Secondary VictimizationCheck all that apply.6a. Adult Physical Assault (Includes Aggravated and Simple Assault)6b. Adult Sexual Assault6c. Adults Sexually Abused/Assaulted as Children6d. Arson6e. Bullying (Verbal, Cyber or Physical)6f. Burglary6g. Child Physical Abuse or Neglect6h. Child Pornography6i. Child Sexual Abuse/Assault6j. Domestic and/or Family Violence6k. DUI/DWI Incidents6l. Elder Abuse or Neglect6m. Hate Crime: Racial/Religious/Gender/Sexual Orientation, etc.6n. Human Trafficking: Labor6o. Human Trafficking: Sex6p. Identity Theft/Fraud/Financial Crime6q. Kidnapping (Non-Custodial)6r. Kidnapping (Custodial)6s. Mass Violence (Domestic/International)6t. Other Vehicular Victimization (e.g., Hit and Run)6u. Robbery6v. Stalking/Harassment6w. Survivors of Homicide Victims6x. Teen Dating Victimization6y. Terrorism (Domestic/International)6aa. Other (describe below)7. Special classification of victims7. N/A7a. Deaf/Hard of Hearing7b. Homeless7c. Immigrants/Refugees/Asylum Seekers7d. LGBTQ7e. Veterans7f. Victims with Disabilities: Cognitive/ Physical /Mental7g. Victims with Limited English Proficiency7h. Other (describe below)7i. If "Other" above please describe here: DIRECT SERVICESWhat type of service was provided?Phone consultation (if same victim is spoken to multiple times during the month only count one time)In person consultation (if same victim is spoken to multiple times during the month only count one time)Attend court proceedings with victim/victims’ familyAttend parole hearing with victim/victims’ familyPress conferenceInformation and referral to other programsHow many times did we provide services? Court proceedings outcome? Parole hearing outcome? How many family members attended the press conference? Description*Please briefly describe each service/interaction.