CalVCP - Dashboard

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Section 1 - Claimant

A Separate application must be filed for each person seeking assistance.

Section 1 must be completed for all applications. The claimant is the person who has expenses or is seeking assistance as a result of a crime. If you are filing this application on behalf of someone else, put their information in Section 1 and your information in Section 3.

First Name

Middle Name

Last Name

Gender

Relationship to victim

Does the claimant have a Social Security Number?

Social Security #

Date of Birth

Mailing Address

Address 2

City

State

Zip

Home Telephone

Work Telephone

Cell Phone

E-Mail

E-Mail Type

From the date of the crime to now, has the claimant been in prison, on probation, on parole or post-release community supervision because of a felony?

Is the claimant required to register as a sex offender?

Check This Box if You Are a Parent/Guardian Applying on Behalf of a Minor Witness to Violent Crime. Minor witnesses are eligible for mental health treatment only. Claimant is under age 18, a witness in close proximity to a violent crime, but is neither the crime victim nor related to the victim. Provide available victim, crime or other information in remaining sections.

If you are an adult victim and the expenses are for you, skip to Section 4. If not, Continue to Section 2

Brother's Death

Progress

Section 1 - Claimant

A Separate application must be filed for each person seeking assistance.

Orion Victims Compensation Program

Brother's Death Edit

Progress

Section 1 - Claimant

A Separate application must be filed for each person seeking assistance.

Orion Victims Compensation Program

Brother's Death