Surviving Violent Crime & Victims' Rights Handbooks Digital Copy Request
By completing this form, the NCVAN website will pop-up for you to download the ENGLISH and SPANISH handbook PDF. Please complete the form to your level of comfort. The first three questions are the ONLY required questions. Questions? Email us at info@nc-van.org
I am a:
*
Please Select
Victim
Loved one of a victim
Professional working with a victim
I wish to not answer
First & Last Name (or Alias/Nickname)
*
Primary Criminal Victimization - Select the option below that best applies. If you are not a victim of crime, please select the first drop-down option.
*
Please Select
I am not a victim of crime.
Adult Physical Assault
Adult Sexual Assault
Adult Sexually Abused/Assaulted as Children
Arson
Bullying
Child Physical Abuse
Child Neglect
Child Sexual Abuse/Assault
Child Pornography
Domestic and/or Family Violence
DUV/DWI Incidents
Elder Abuse or Neglect
False Imprisonment
Hate Crime
Human Trafficking: Labor
Human Trafficking: Sex
Identity Theft/Fraud/Financial Crime
Kidnapping (non-custodial)
Kidnapping (custodial)
Loved Ones of Homicide Victim(s)
Mass Violence (Domestic/International)
Other Vehicular Victimization
Property Crimes: Destruction/Damage to Property, Vandalism
Robbery
Stalking/Harassment
Teen Dating Victimization
Theft
Terrorism (Domestic/International)
Violation of a Court (Protective) Order
Email
example@example.com
County
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
*Notice* the next two pages are OPTIONAL. Continue to the "Submit" button at the bottom of page 3 if you wish to NOT answer additional questions.
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(OPTIONAL) If you are a victim, or a loved one of a victim, please complete the following questions based on your level of comfort.
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. Skip until the "Submit" button if you are not interested in completing the questions below.
Date of Birth
-
Month
-
Day
Year
Date
Ethnicity
Please Select
American Indian or Alaska Native / Indigenia de EEUU o nativa de Alaska
Asian / Asiático
Black or African American / Negra o afromericano
Hispanic or Latino / Hispano o latino
Native Hawaiian or Other Pacific Islander / Nativo hawaiano u otro isla del Pacífico
White Non-Latino or Caucasian / Blanco o caucásico no latino
Some Other Race / Otra Race
Multiple Races / Varias Razas
Prefer not to answer / prefiero no responder
Other
Gender Identity
Please Select
Male / Masculino
Female / Feminino
Gender identity not listed / Identidad de género no esta en la lista
Prefer not to answer / Prefiero no responder
Other
(Select all that apply):
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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(OPTIONAL) If you are a victim advocate or other allied professional, please note your organization and discipline below:
Organization/Agency:
Name of Organization
Victim Service Professional Discipline:
Law Enforcement
Victim Advocate in Law Enforcement
Non-profit advocate/staff (ex. DV/SA organization)
Hospital/Medical
Military/National Guard
Mental Health Professional
Chaplin/Faith-based
University/Campus
Court Support Staff (ex. Victim Witness Legal Assistant)
Children's Advocacy Center Staff/Advocates
Other (Please describe below)
If you selected "Other" above, please explain:
Submit
Should be Empty: