Amherst County Victim/Witness Program

Services Survey

Question Title

* 1. Gender

Male

Female

Other (please specify)

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* 2. Marital Status

Married

Single

Divorced

Separated

Widowed

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* 3. Race

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* 4. Age

Under 12

13-17

18-24

25-59

60+

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* 5. Victim of:

Rape/Sexual Assault

Assault/Domestic

Family Member of Homicide Victim

Property Crime (Damage, Fraud, Robbery, Embezzlement, Credit Card Theft, Forgery)

Harassment/Threats

Other (please specify)

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* 6. Services Received:

Applying for Victim Compensation

Getting Restitution

Travel Reimbursement

Help in Court

Emotional Support

Signing up for Vinelink

Victim Impact Statement

Getting a Protective Order

Talking w/ Police/Lawyers

Did Not Receive Services

Other (please specify)

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* 7. Were the services helpful?

Yes

Somewhat

Why? (please specify)

Amherst County Victim/Witness Program

Services Survey

Question Title

* 1. Gender

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* 2. Marital Status

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* 3. Race

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* 4. Age

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* 5. Victim of:

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* 6. Services Received:

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* 7. Were the services helpful?

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* 8. How can we improve the program?