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As a way to provide better access to wellness in our community, we provide our services at a free or reduced cost. To meet the expectations of the Department of Justice Victims of Crime Act (VOCA) and in order to gain the funding necessary to provide free services, it helps us to learn more information about our community. This survey gives us insight into the experiences of who we are serving and helps us to adjust our services to the needs. 

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* 1. Date

Date

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* 2. Service Used/Event

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* 3. Race/Ethnicity/Tribe

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* 4. Gender

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* 5. Age

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* 6. Are you a Wisconsin Resident? 

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* 7. If you are not a Wisconsin resident, what state do you reside?

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* 8. Have you or your family been impacted by any of the crimes listed in the next question?

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* 9. If yes, please check those that you or a family member has experienced:

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