Crime Victim Justice Unit Complaint Form Page 2
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2
3
4S
4. I
A
C
RIME
ECTION
NFORMATION
BOUT THE
(The following section gives us important information about the crime; please fill out this section completely.)
Offender/suspect's name
Offender/suspect's
Relationship between victim and offender:
:
date of birth
Current/Former Spouse or
Stranger
Boyfriend/Girlfriend
Friend
Parents/Step-Parent
Other (describe)
Other Relative
Police/sheriff's dept. crime reported to:
Police/sheriff case number:
Investigating officer's name:
Date of the offense:
City in which crime occurred:
County in which crime occurred:
S
5. I
A
C
ECTION
NFORMATION
BOUT YOUR
OMPLAINT
What agency or organization do you have a complaint against?
Yes
No
Is your complaint against a specific person in that agency or organization?
If yes, please specify:
Did you receive a Notice of Crime Victim Rights
s at the time of the incident?
card or information about victim right
Yes
No
Don't Recall
Yes
No
Don't Recall
At a later time?
Yes
No
Have you spoken to an advocate?
If so, whom?
Name of advocate's agency:
Please identify the problem you had with the person or agency you are complaining about.
(You will have a chance to describe your situation in detail on page 3.)
I did not get proper notice or information about the case.
Please describe:
I did not have a chance to participate in the case (for example, attend a hearing or give a victim impact
statement).
Please describe:
I do not agree with the decision or actions taken.
Please describe:
I feel that the investigation or prosecution of my case was not handled properly.
Please describe:
I feel that I was treated inappropriately.
Please describe:
Other:
Please describe:
Please list names and phone numbers of other professional contacts related to the case:
Name
Organization/agency
Telephone
Crime Victim Justice Unit Complaint Form
Page 2
Rev: 11-08
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