Office of the Victim Advocate Online Submission Form

Complainant Information

* indicates a required field.

First Name *

Last Name *

Mailing Address *

Town *

State *

Zip Code *

Phone * 123-456-7890

Preferred Method of Contact *

Phone

If Email selected, please make sure email address field above is completed.

Best Time to Call *

Who Is The Complaint Against?

Please choose who the complaint is against.

Advocate

Court

Law Enforcement Agency

Prosecutor

Other

If Other is chosen as who the complaint is against, please explain:

Please describe the efforts made to resolve this matter with the person or agency above. Include contact information of those you have been in communication with.

Resolution Efforts

Victim Information

Check here if Victim is the same as Complainant

Because this is a secure system intended to protect your personal information, please carefully review each field before selecting the "Next" button. Failure to answer all required questions will result in having to re-enter your information.

Office of Governmental Accountability Office of the Victim Advocate

Office of the Victim Advocate Online Submission Form

Complainant Information

Alleged Violation of Rights

Who Is The Complaint Against?

Victim Information