Are you in need of financial assistance for any of the following, or have you had to pay for any of these services due to being a victim or a family member of a victim of crime in Massachusetts within the last three years?
o Lost wages (for victim only)
o Loss of financial support (for dependents of homicide victims)
o Funeral/burial
o Crime scene cleanup*
o Forensic Sexual Assault Exam associated expenses*
o Medical services*
o Medical supplies/pharmacy*
o Dental services*
o Replacement homemaker services*
o Ancillary funeral/burial expenses*
o Replacement bedding/clothing*
o Counseling for victim*
o Counseling for family members of homicide victims*
o Counseling for children who witness violence against a family member*
o Security Measures*
o Counseling for non-offending parents of a child victim