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Crime Victim Compensation Application

*Secondary Victims and *Homicide Survivors are encouraged to apply by calling 1-800-373-5044 or downloading applications here. The online application below is intended for Primary Victim applications only. Definitions of Primary Victim, Secondary Victim, and Homicide Survivor can be found here. For more information, download this quide.

* Indicates a required field

Crime Victim's Information

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Full name of the person completing this form:

Contact email address:

Type of Crime:

I am the:

Victim of the crime.

Parent, guardian, or victim's survivor.

Preferred method of contact (we must be able to reach you for more information):

Telephone

Standard mail

Please Note: This form can take several minutes to process. Please press the "Next" or "Submit" buttons once when finished. Our team appreciates your patience.

For help, contact Victim Specialist Natalie Lampley.