Sexual Abuse Complaint Form

Thank you for your willingness to share information with our office. A member of our investigative team will review all allegations reported through this form.

To learn how we safeguard your personal information, please read our PRIVACY POLICY.

Contact information

Full name

Street address

City/town

State

Zip

(ex: 12345 or 12345-1234)

Phone

Email

Are you requesting confidentiality?

Are you the victim?

What is your relationship to the victim?

Are you represented by an attorney?

Name of attorney

Attorney phone

Attorney email

About the incident(s)

Where did the incident(s) occur?

Year(s) abuse took place

Name of perpetrator

Name of institution

Please select diocese:

Is the alleged perpetrator a diocesan priest?

Did you (or the victim, if a secondary report) participate in the IRCP program? [Independent Reconciliation and Compensation Program]

Was the incident reported at the time -- or soon after -- it occurred?

When was it reported?

To whom was it reported?

Did you (or the victim, if a secondary report) receive a response from the diocese or organization in question?

Please describe response.

Witnesses (if any)

Other victims (if any)

Describe the nature of the incident(s)

(Type of abuse that occurred, victim’s relationship with perpetrator of the abuse, duration of abuse)

Please check to acknowledge. In submitting this information, I understand that:

Note: All boxes must be checked before submission

The Attorney General is not my private attorney, but represents the public in enforcing laws designed to protect the public from misleading or unlawful practices. My filing this complaint does not mean that the Attorney General has initiated a lawsuit or proceeding on my behalf or that it will do so.

The Attorney General cannot give me legal advice or represent me in court. If I have any questions concerning my legal rights or responsibilities, I should contact a private attorney.

An investigator may follow up with you regarding this complaint for additional details.