TYPES OF VICTIMIZATIONS (for ALL individuals identified in Question 1) Individuals who received services by type of victimization. INSTRUCTIONS: Enter a count for each victimization type of individuals who received services based on their presenting victimization type(s) during the reporting period. An individual may be counted in more than one victimization type. Do not count an individual more than once for the same victimization type. SEE APPENDIX FOR DEFINITIONS VICTIMIZATION TYPE A. Number of individuals who received services based on a presenting victimization during the reporting period. Adult Physical Assault (Includes Aggravated and Simple Assault) Adult Sexual Assault Adults Sexually Abused/Assaulted as Children Arson Bullying (Verbal, Cyber or Physical) Burglary Child Physical Abuse or Neglect Child Pornography Child Sexual Abuse/Assault Domestic and/or Family Violence DUI/DWI Incidents Elder Abuse or Neglect Hate Crime: Racial/Religious/Gender/ Sexual Orientation/Other (Explanation Required) Human Trafficking: Labor Human Trafficking: Sex Identity Theft/Fraud/Financial Crime Kidnapping (non-custodial) Kidnapping (custodial) Mass Violence (Domestic/International) Other Vehicular Victimization (e.g., Hit and Run) Robbery Stalking/Harassment Survivors of Homicide Victims Teen Dating Victimization Terrorism (Domestic/International) Violation of a Court (Protective) Order Other (Provide number and description) If other, please explain: TOTAL B. Of the number of individuals receiving services, the number who presented with more than one type of victimization during the reporting period. C. Special classification of individuals (self-reported) INSTRUCTION: Enter the number of individuals who self-identify in one of these categories. Deaf/Hard of Hearing Homeless Immigrants/Refugees/Asylum Seekers LGBTQ Veterans Victims with Disabilities: Cognitive/ Physical /Mental Victims with Limited English Proficiency Other (List the types) If other, please explain:
SUBGRANTEE ANNUALLY REPORTED QUESTIONS Number of requests for services that were unmet because of organizational capacity issues. Please explain. 14. Please discuss some of the challenges your victim assistance program faced during the course of the federal fiscal year. VOLUNTEERS: Indicate the number of volunteer staff utilized this quarter. This is a mandatory VOCA requirement. Number of volunteers utilized this quarter: VICTIM SERVICES PRACTITIONER DESIGNATION: To ensure compliance with the VOCA Agreement, this information must be provided for each quarter report even if the same person is indicated on each report. Therefore, list the name of a current staff member who has completed the Victim Services Practitioner Designation Training, and the expiration date of the current certification. Please note: The Victim Services Practitioner Designation is valid for a period of four years from the date that appears on the “Victim Services Practitioner” designation certificate. It is the responsibility of the individual to renew his/her designation. Apply for renewal of the designation with the Office of the Attorney General pursuant to the renewal criteria outlined on the OAG website. Name Expiration Date of Current Certification Has the training been completed by at least one member of the agency's staff? Yes No Name Date training was completed CERTIFICATION: I hereby certify that the information contained in this report is true and correct to the best of my knowledge and that the supporting documentation is currently on file at the office of the Provider and is available for inspection upon request by the Office of the Attorney General or its authorized representative. Agency Name Grant Number Prepared by Phone No. Fax No.