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About the crime
Crime type
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Burglary
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Please specify
Incident date
Was the crime reported to the police?
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Was the crime domestically motivated? (for example were/are you in an intimate relationship with the perpetrator or are they a family member?)
Yes
No
Was the crime a hate crime? (motivated by prejudice against your religion, sexual orientation, race or disability)
Yes
No
Experience
Please outline your experience as a victim. Please do not feel obliged to share anything you are uncomfortable with our team knowing or details that may identify you or others.
What is the number one thing you would change if you could about the criminal justice system?
Contact
Do you consent to anonymised quotes from your experience being used in any literature or messaging produced by our office?
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Would you like us to contact you about your experience?
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Please provide your contact details
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