Office of the Victim Advocate Online Submission Form

Complainant Information

* indicates a required field.

123-456-7890

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

Alleged Violation of Rights

Choose the Right that has allegedly been violated.

Who Is The Complaint Against?
Please choose who the complaint is against.

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.

Victim Information

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.