Please provide the name of each person or agency that you believe did not provide you with one or more of your rights or did not treat you with respect and dignity: Please tell us what happened: May we share the information you provided with the person or agency against which you are filing this complaint as appropriate? Please send this completed form via e-mail to If you prefer to mail the form or documents to us, please use the following address: Pennsylvania Office of Victim Advocate 1101 South Front Street, Suite 5200 Harrisburg, Pa 17104 July 2012
Please provide the name of each person or agency that you believe did not provide you with one or more of your rights or did not treat you with respect and dignity: Please tell us what happened: May we share the information you provided with the person or agency against which you are filing this complaint as appropriate? Please send this completed form via e-mail to If you prefer to mail the form or documents to us, please use the following address: Pennsylvania Office of Victim Advocate 1101 South Front Street, Suite 5200 Harrisburg, Pa 17104 July 2012
Victim%20Complaint%20Form.docx