Request a copy of the combined handbooks: Surviving Violent Crimes and Victims Rights

Name(Required)

First Last

Which handbook would you like?(Required)

Number of handbooks being requested

How would you like the handbook sent?(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

I am a:(Required)

Criminal Victimizations

Demographics

Collecting demographic information helps us (and our funders) to better understand what groups in the community we are and are not serving so that we can improve our outreach, but it is always optional. You do not need to answer these questions to receive a handbook, but we do appreciate any information you are willing to provide.

Ethnicity

Gender Identity

Disabilities

Deaf or Hard of Hearing / Sordo o dificultades auditivas

Homeless (Includes those residing in shelters or in other temporary housing such as a friend's couch) /Personas sin hogar (incluye a los que residen en refugios o en otras viviendas temporales, como el sofá de un amigo)

Immigrant / Inmigrante

LGBTQIA+

Veteran / Veterano

Person with Disabilities: Cognitive or Physical / Persona con discapacidades: Cognitivo o Físico

Limited English Proficiency / Dominio limitado de la idioma inglés

None of the above or prefer not to answer / Ninguna de las anteriores o prefiero no contestar

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