Victim Assistance & Restorative Justice Program Apology Letter Request Form


Victim Assistance & Restorative Justice Program
Apology Letter Request
Date of request: ____________________
Victim/ Survivor Name:
Your Name:
Mailing address:
Phone number:
Cell phone:
Email address:
Offender Name:
Association to Offense:
Victim/Survivor of the offense
Community member
Victim/Survivor family member
Offender family member
The needs of victims/survivors is of the utmost importance to the Department of Corrections.
Please take some time and share what is important for you to hear or learn from an offender
apology letter. While we cannot guarantee the offender will or can address all of the areas you
outline, this information can help staff hold offenders accountable and cause no further harm.
You may attach additional sheets of paper if needed.
Please check the box(es) of the things that you would like to see in the apology letter.
Taking responsibility/accountability
Expressing remorse and empathy.
for the crime and the harm he/she
Saying “I’m sorry”.
Recognizing the harm they caused
Insuring that no further harm will
and the impact of the harm.
occur to you or others.
Other _______________________
How treatment/programming has
changed behaviors and criminal
thinking to prevent future harm.


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