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2. Case Information

   Please enter the following information, if known.

4. Court File Number
5. Juvenile's Name
7. Your Information
9. First Name
10. Middle Name
11. Last Name
13. Email Address
14. Date of Birth
16. Home Phone Number
17. Mobile Phone Number
18. Work Phone Number
20. Mailing Address
22. City
23. State
24. Zip Code
26. Physical Address

    If different from your mailing address.

28. City
29. State
30. Zip Code
32. Alternate Contact Person

    Is there someone else that we can contact to get in touch with you?

33. Relationship
34. Phone Number
36. Demographics

    Optional - this information is used for grant and other reporting purposes.

38. Gender
    -- Select One --MaleFemaleOtherNot Applicable
39. Race/Ethnicity

    1. American Indian/Alaskan Native
    2. Asian
    3. Black/African American
    4. Hispanic/Latino

    1. Native Hawaiian/Pacific Islander
    2. White/Caucasian
    3. Other
41. Special Classification(s)

    1. Deaf/Hard of Hearing
    2. Cognitive/Physical/Mental Disability
    3. Homeless

    1. Limited English Proficiency
    2. Immigrant/Refugee/Asylum Seeker
    3. Veteran

    1. LGBTQ
    2. Other
45. Contact Preferences
47. I prefer to be contacted by:

    1. E-Mail
    2. Regular Mail

    1. Cell Phone
    2. Home Phone

    1. Work Phone
    2. Other
49. The best days/times to reach me are:
53. Desired Outcome

    Although it is the responsibility of the prosecutor to negotiate and the court to impose the final sentence, your opinion is important and can assist the Office of the Winona County Attorney in negotiating an appropriate plea agreement in this case.  In the following section, please indicate what you would like to see happen with this case. Some of the options are:

    Restitution:  The offender is ordered to pay money to reimburse the victim for losses that are a result of the crime.  More information about the process for obtaining restitution will be sent to you at a later date.

    No contact order:  The offender is ordered to have no contact with the victim.

    Counseling/Treatment:   The offender is ordered to undergo evaluations and/or participate in treatment or programs such as NA, AA, domestic abuse program, chemical dependency treatment, mental health counseling, etc.

    Community Service:  The offender completes hours or days of service to the community as part of probation.

55. Outcomes

    1. Restitution
    2. No Contact Order
    3. Counseling/Treatment (please put what kind in the comments section)
    4. Community Service (please put how much in the comments section)
    5. Other (please explain in the comments section)
    6. No preference what happens to the juvenile.
56. Outcome Comments
60. Participation Preferences
62. Please contact me...

    You may still be contacted, even if you do not make any requests in this section.

    1. I have questions for the Victim Services Coordinator
    2. I would like to provide information to the court about the impact this offense has had on me and my family.
    3. I would like more information about the court process.
64. I wish to submit...

    1. Victim Impact Statement (written or oral statement to the Court regarding how this crime has impacted your life emotionally, physically, and/or financially)
    2. Request for Restitution (for out-of-pocket costs this incident has caused you).
66. Case Notifications

    You have a right to be notified of the developments of this case and any outcome, even if you do not have a specific request related to how this case should be decided.  In order to ensure that you receive all information that you are entitled to the Winona County Attorney's Office will send you written notifications and information throughout the process of this case.   However, there may be circumstances under which you do not wish to receive written notifications.  Please indicate the notifications you wish to receive.

    You will continue to receive notifications unless you indicate your preference otherwise.

68. Status Update Notices

    Notices providing information about what happened at a hearing and what the next step(s) in the process will be.   Declining these notices does not include hearing notices or subpoenas requiring testimony at a hearing.

    1. Yes, please send these notices.

    1. No, I do not want these notices.
70. Plea Negotiation Notices

    Notices providing information about what plea agreement(s) is/are being considered by the prosecutor and defense attorney.

    1. Yes, I want to be contacted about plea negotiations.

    1. No, I do not want to be contacted about plea negotiations.
72. Disposition Notices

    Notices providing information about the final outcome of the case and any changes in final disposition.

    1. Yes, I want notices about the final disposition.

    1. No I do not want notices about the final disposition of the case.
74. Exceptions

    Please indicate if there are any exceptions to your notification preferences (things you do or do not want to be notified of that would be different from what you indicated above).

76. Thank you for taking the time to complete this form.

    If you have any other information you would like the prosecutor to know or take into consideration during the course of this case, please contact our Victim Services Office at (507) 457-6586 or VictimServices@co.winona.mn.us.

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78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field