2. Your responses to this survey will assist in providing grant funds necessary for the Victim Advocate program. Please answer all of the questions.
4. What type of victimization(s) did you or a loved one experience?*
6. How did you find out about the Ormond Beach Police Department Victim Advocate Program?*

   1. Brochure
   2. Direct contact from the program

   1. Police Officer
   2. Referral from another agency

   1. Website
   2. Other (please specify below)
8. If you selected "Other" above, please specify:
10. What service(s) did you receive? (Indicate all that apply.)*

    1. Information - Criminal Justice System
    2. Information/Assistance - Injunctions for protection (restraining order)
    3. Information - Victim compensation
    4. Information - Victim rights
    5. Information - Your case

    1. In-person contact
    2. Personal advocacy
    3. Referral(s) to other agencies for services
    4. Telephone contact
    5. Other (please specify below)
12. If you selected "Other" above, please specify:
14. Would you use the services of the Ormond Beach Victim Advocate Program again, if needed, or recommend the program to a friend?*

    1. Yes

    1. No
16. Additional Comments:
18. Would you like to be contacted about your responses?*

    1. Yes

    1. No
20. If yes, please provide your contact information.
22. First Name:
23. Last Name:
25. Address:
27. City:
28. State:
29. Zip:
31. Phone Number:
32. Email Address:
34. Thank you for completing this survey.
Leave This Blank:


36. Submit

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