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2. Court File Number
3. Defendant's Name
5. Post-Disposition Survey

   Please help us evaluate our services to victims of crime in Winona County by answering the following questions about your contact with our office. All responses will be kept confidential.

7. 1. The Victim Services Office worked with me through (check all that apply):

   1. In Person
   2. Phone

   1. Letter
   2. Email

   1. Text Message
   2. Social Media

   1. Other
9. 2. The Victim Services Office answered my questions and addressed my concerns.

   1. Yes

   1. No

   1. See Comments
11. 3. The information sent to me by the Victim Services Office was helpful.

    1. Yes

    1. No

    1. See Comments
13. 4. The Victim Services Office informed me about:
15. a. The charges filed in the case

    1. Yes

    1. No

    1. See Comments
17. b. How to receive notifications about court hearings in the case.

    1. Yes

    1. No

    1. See Comments
19. c. Restitution and/or victim impact statements.

    1. Yes

    1. No

    1. See Comments
21. d. The possible plea offer to resolve the case.

    1. Yes

    1. No

    1. See Comments
23. e. The disposition of the case.

    1. Yes

    1. No

    1. See Comments
25. 5. As a result of the information I received, I better understand:
27. a. My rights as a victim.

    1. Yes

    1. No

    1. See Comments
29. b. How to complete a restitution affidavit.

    1. Yes

    1. No

    1. See Comments
31. c. How to provide a victim impact statement.

    1. Yes

    1. No

    1. See Comments
33. d. How to receive further notifications (probation violation, offender release, etc.).

    1. Yes

    1. No

    1. See Comments
35. 6. The Victim Services Office provided sufficient information about the case.

    1. Yes

    1. No

    1. See Comments
37. 7. A representative from the Victim Services Office was available to attend court hearings if I wanted someone to attend the hearing with me.

    1. Yes

    1. No

    1. See Comments
39. 8. Overall, I was satisfied with the services I received from the Victim Services Office.

    1. Yes

    1. No

    1. See Comments
41. 9. Comments
43. Demographics

    The following information is optional. It is used for grant or demographic reporting purposes. Please check any/all that you identify with.

45. Race/Ethnicity

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

    1. Hispanic/Latino
    2. Native Hawaiian/Pacific Islander

    1. White/Caucasian
    2. Other
47. Gender

    1. Male

    1. Female

    1. Other

    1. Not Applicable
49. Special Classification

    1. Deaf/Hard of Hearing
    2. Veteran
    3. LGBTQ

    1. Homeless
    2. Limited English Proficiency

    1. Cognitive/Physical/Mental Disability
    2. Immigrant/Refugee/Asylum Seeker
51. Contact Information
53. First Name
54. Middle Name
55. Last Name
57. Email Address
59. Address
61. City
62. State
63. Zip Code
65. Home Phone Number
66. Mobile Phone Number
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

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