EFTA00006055.pdf

Vision 
Justice for all crime victims. 
Mission Statement 
With compassion and respect, 
we assist victims of sexual 
evil- et, domestic violence, 
homicide, and other violent 
crimes through crisis response, 
advocacy, therapy, and 
community awareness. 
Palm Beach County 
Victim Services 
is a Certified Rape Crisis Center 
that provides therapy services to 
all crime victims in Palm Beach 
County regardless of the victims' 
race, sex, color, religion, national 
origin, disability, sexual 
orientation, marital status, 
familial status or gender identity 
or expression. 
Start by Believing: 
Start by 
r  
A Public Awareness 
Believing 
Campaign to 
Change the Way 
We Respond to Sexual Violence in Our 
Community... one response at a time. 
YOUR REACTION 
MAKES THE DIFFERENCE. 
When someone tells you they've 
been raped. there's a simple response. 
Start by Believing. 
kilo. 
it . tr.; 
county 
Safety .Department 
jiiiedin Services Division
wwwpbcgov.com/publitsafety/victimSeeVicett 
24/7 SEXUAL ASSAULT 
VIOLENT CRIME HELPLINE 
HELPLINE: (561 -8$3`7273 
TOLL FREE: (866) 891.7273 
1:.N 
Eoi rehouse 
-'205 45itil Utile Hwy , Suite 5.1109 
West Palm Beach. FL 33401 
(561) 355-2418 option 3 
TTY: (561) 233-2595 
Victim Services SART Center 
42113 North Australian Ave. 
Vilest Palm Beach. FL 33407 
(561)625.2568 option 1 
• 
TIT (561) 6244520 
Noith County Courthouse 
3188 PGA Blvd.. Suite 1436 
Palm Beach Gardens, FL 33410: 
(561) 355-2418 option 3 
' 
(561) 624.6643 
South County Courthouse 
200. West lykraje Ave., Suitt E-301 
DenyW4aeh. 
(50) 274:1500 
ITV: (561) 274-1015 
es" 
West County-Glades Courthouse 
2976 $tate n&d 15. 2nd Floor 
Belle Glade, FL 33430 
(561) 996-4871 
ITV; (561)992-1113.._ -.-
--Like Us on 
przvictimsgrytces 
Sart-gifts are funded through Palm Beachtounty Board of 
County Cornthissioners with grants fronithe OKI& of the - 
AttorpeyGeneral and Honda Council Against Sexual Violence;;.,-. 
-0, 
Palm tescItCounly 
N
Palm Beach 
ti 
• '. 
'Public Sa...

Have You Been 
,. 
A Victim Of A Crime? 
Do' Thu Experience 
Any Of The Following? 
* Inability to fall orstay asleep? 
* Feeling anxious or depressed? 
* Having outbursts of anger? 
* Inability to concentrate? 
* reeling emotionally numb? 
* Loss of interest in the things you used to enjoy? 
* Painful memories of the traumatic event? 
* Bad dreams about the traumatic event? 
* flashbacks or a sense of reliving the events? 
* Racing thoughts? 
* Physiological stress response to reminders of the 
event? (pounding heart, rapid breathing, nausea, 
muscle tension, sweating) 
Palm Beach County provides equality of services and 
care to everyone, regardless of people's age, disability. 
gender. gender identity, race, religion or belief or 
sexual orientation. 
Free services include individual therapy 
for children and adults and adult-support 
groups. 
If you are a crime victim or have been 
a victim of crime in the past and are 
considering therapy, we welcome your coll. 
Therapists are available for appointments 
Monday through Friday, excluding legal 
holidays. 
Therapists Will Help You: 
O Identify trauma reactions 
O Explore the impact that trauma has on your daily life 
O Reduce the intensity of negative emotional 
responses and symptoms 
O Learn about common trauma reactions and 
phases in healing 
O Feel hopeful and positive regarding the future 
O Develop coping mechanisms to utilize when 
thinking or talking about the crime 
O Experience a reduction of trauma symptoms 
O Return to work or school 
O Explore the impact on current and future 
relationships 
erapy For 
Children & Teenagers 
O Assessment and treatment for child victims 
of crime
O Therapeutic interventions that teach 
child safety 
• 
.0 Play Therapy 
.0 Assistance for parents during this 
difficult time 
Signs Of lPauma In Children 
O Sadness: The child may feel despondent or 
hopeless The child may cry easily or withdraw/ 
isolate from others. 
O Loss of interest in activities: The child may 
compl...

Vision 
Justice for all crime victims. 
Mission Statement 
With compassion and respect, we assist 
victims of sexual assault, domestic violence, 
homicide, and other violent crimes through 
crisis response, advocacy, therapy, and 
community awareness. 
Florida Statute 960 Provides 
Guidelines For Fair lFeatment 
& Specific Rights For Victims 
In The Criminal Justice System 
Some of these include the following: 
O Office of Attorney General Crime Victim 
Compensation, when applicable; 
O lb be informed, present, and heard, when 
relevant at all crucial stages of criminal or 
juvenile proceedings, to the extent that right 
does not interfere with the Constitutional 
rights of the accused; 
0 lb be provided information concerning 
services available including Victim 
Compensation, community treatment 
pnagrams, crisis intervention services, 
counseling and social services; 
0 lb a prompt and timely disposition of the case. 
to the extent that this right does not interfere 
with the Constitutional rights of the accused; 
0- lb have your property returned to you as soon 
as possible after the investigation and/or 
prosecution is completed, unless there is a 
compelling reason for its retention; 
O Have a Victim Advocate present during 
depositions of the victim; 
0 Request, for specific crimes, an exemption 
prohibiting the disclosure of information to 
the public which reveals your identification. 
Palm Beach County 
Public Safety Department 
Victim Services Division 
www.pbcgov.comipublicsafety/victimservices 
24/7 SEXUAL ASSAULT 
VIOLENT CRIME HELPLINE 
HELPLINE: (561) 833.7273 
TOLL FREE: (866) 891.7273 
Main Courthouse 
205 North Dixie Hwy., Suite 5.1100 
West Palm Beach, FL 33401 
(561) 355-2418 option 3 
TTY: (561) 233.2595 
Victim Services SART Center 
4210 North Australian Ave. 
West Palm Beach, FL 33407 
(561) 625.2568 option 1 
TTY: (561) 624.6520 
North County Courthouse 
3188 PGA Blvd., Suite 1436 
Palm Beach Gardens, FL 33410 
(561) 355-2418 option 3 
TTY: ...

Sexual Assault 
Domestic Assault 
Services Provided 
Professional butting and community 
presentations are also available. 
O. Information about Victims' rights 
4. 24-hour crisis response to hospitals, law 
enforcement agencies and crime scenes 
0 Sexual Assault Nurse Examiner (SANE) and a 
Forensic Exam site ti The Butterfly House 
4 Sexual Assault Response Team (SART) 
to provide Victim-centered assistance 
-4 Criminal Justice advocacy and 
court accompaniment 
4 Assistance with filing State Crime 
Victim Compensation applications and 
Restraining Orders 
O Individual therapy and support groups 
0 Information and referral to community 
resources, including shelters and Legal Aid 
Palm Beach County provides equality of services and 
care to everyone, regardless of people's age, disability. 
gender, gender identity, race, religion or belief or 
sexual orientation. 
Sexual Assault is a violent crime including rape, 
incest, sexual harassment or any other sexual 
contact without consent. 
Per Florida Statute 90.5035. a victim of sexual 
violence who consults a sexual assault counselor at 
a rape crisis center has the right to confidentiality of 
information shared with the counselor. 
No one except the victim can compel the sexual 
assault counselor to reveal information about their 
communications. Only the victim can waive the 
privilege, and this must be done in writing. 
If rape victims are not sure whether to report to law 
enforcement, victim advocates will assist them 
through their decisionmaking process, respecting 
whatever choices are made. 
Certified Rape Crisis Victim Advocates 
Will Provide: 
4 Crisis Intervention and Personal Advocacy 
Accompaniment during forensic rape exams at 
The Butterfly House and other medical facilities 
0 Coordination of follow-up medical care, therapy 
and referrals 
4 Criminal Justice advocacy and court accompaniment 
Start by MS, 
Believing 
Start by Believing: A Public 
Awareness Campaign to Change 
the Way We Respond to S...

Help is Available 
Victims of sexual crimes need 
compassion, sensitivity and empathy. 
Being the victim of a crime can be 
overwhelming. Your reactions are normal. 
Local certified rape crisis centers have 
advocates who are there to help all 
victims, regardless of whether or not 
they report to law enforcement. 
Services are free and confidential —
certified rape crisis centers are legally 
and ethically required to protect your 
confidentiality, unless you allow, in 
writing, the release of your information. 
Advocates are available to: 
• Provide crisis intervention 
• Speak to you on the 24-hour hotline 
• Discuss your options 
• Navigate available resources 
• Go with you to appointments 
• Address safety concerns 
• Advocate on your behalf 
• Help you apply for victim compensation 
Sexual Battery is a Crime! 
In Florida, the legal term for rape or 
sexual assault is sexual battery (F.S. 
794.011). Sexual battery means oral, 
anal, or vaginal penetration by, or union 
with, the sexual organ of another or the 
anal or vaginal penetration of another by 
any other object, committed without your 
consent. 
Consent means Intelligent, knowing, 
and voluntary consent and does not 
include coerced submission. Failure to 
offer physical resistance to the 
offender does not imply consent. 
A person under 16 years of age 
cannot legally consent to sex. Also, a 
person 24 years of age or older or a 
person in a familial or custodial 
position of authority cannot receive 
consent from 16 and 17 year old 
minors. 
Forensic Exam 
What is a forensic exam? 
The forensic exam is a head-to-toe exam to collect 
evidence and check for injuries after a sexual crime. 
What are my rights with regard to the 
exam? 
• Stop the exam at any time 
• Have an advocate from a rape crisis center with 
you 
• Be informed about the status of the kit during 
processing 
What evidence is collected? 
During the exam, the medical professional may collect 
blood, urine, saliva, pubic hair combings ...

You have the right to: 
• Obtain a forensic exam whether or not you report 
to law enforcement 
• Have an advocate at the forensic exam with you 
• Have the forensic exam sent for testing within 30 
days, if reported to law enforcement 
• Review the law enforcement report prior to final 
submission 
• Be informed, present, and be heard at all crucial 
stages of the criminal or juvenile proceeding 
• Have an advocate with you during a discovery 
deposition 
• Have identifying information about the criminal 
investigation kept confidential 
• Have the offender, if charged, tested for HIV and 
hepatitis 
• Attend sentencing or disposition of the offender 
• Notification of judicial proceedings and scheduling 
changes 
• Notification about the release of incarcerated 
offender 
• Request restitution 
• Give a victim impact statement 
• Not be subjected to a polygraph 
• Take up to 3 days of leave from work (with eligible 
employer) 
• Apply for an injunction if you fear for your safety or 
offender is nearing release 
Victim Compensation 
You may be eligible for 
financial assistance for: 
• Medical Care 
• Lost Income 
• Mental health services 
• Relocation 
• Other expenses related to injuries as a result 
of the crime 
Contact your local certified rape 
crisis center for more information. 
This project was supported by Grant 
No. 2015-WL-AX-0037 awarded by 
the Office on Violence Against Women, 
U.S. Department of Justice. The 
opinions, findings, conclusions, and 
recommendations expressed in this 
publication are those of the author(s) 
and do not necessarily reflect the views 
of the Department of Justice, Office on 
Violence Against Women. 
Resources 
Florida Council Against Sexual Violence 
1-888.956-7273 
www.fcasv.org 
Victim Compensation 
1-800-226-6667 
www.myfloridalegal.com 
Florida Department of Law Enforcement 
Sexual Offender/ Predator Unit 
1-888-357-7332; 1-850.410.8572 
For TTY Accessibility: 1-877-414-7234 
E-mail: sexpred@fdle.state.fl.us 
Florida ...

Center for Trauma Counseling 
Where Your Emotional Healing Can Begin 
A non-profit Community Counseling Center 
Serving Palm Beach County and beyond 
Individual, Couples, Family, & Group Therapy 
Services for Children (3 y/o) to Adults (99 +) 
We offer affordable counseling services to those that are insured and not insured. 
Insurance accepted: Cigna, Humana Commercial, Magellan, Beacon (Humana Medicaid, 
Coventry) 
Sliding Scale: Reduced fees based on income for those who qualify 
Languages Spoken: English, Spanish, and Farsi 
Evidence Based Models: Play/Sand Tray therapy, EMDR, Trauma Focused Cognitive Behavioral 
Therapy 
Hours: Monday-Friday, Saturdays and evening appointments available 
Referral Process: Call 561-444-3914 (Office) email: info@palmbeachmentalhealth.org 
Center for Trauma Counseling, Inc. 
6801 Lake Worth Road, Suite 307 
Greenacres, FL 33467 
Office: 561-444-3914 
www.parrnbeachmentalhealth.org 
EFTA00006061

Office of the Attorney General 
The Capitol. PL-01 • Tallahassee, FL 3230-1050 . Office: (800)2264687 Fax: (853) 414.6191 
Bill Status Inform:tier for Providers 050) 414-3331 • TDD users may call through Florida Relay Service at 1.803.9558771 
'Nebsite: myfloridalegalcom • Email address: vointake@myfloridalegal.com 
BUREAU OF VICTIM COMPENSATION CLAIM FORM 
Instructions 
Please read the Eligibility Requirements to see if you qualify for this program. Fill out this form completely (please print). attach all required 
documentation. and submit to the above address. I' you move or change your address. you are required to notify this office. 
CHECK THE TYPE Of VICTIM COMPENSATION BENEFITS YOU ARE REQUESTING: 
Fl DISABILITY - compensation for the victim who suffered a Donnell cisatilty. 
I—I (Attach documentasn as cktined in Section 3.) 
Eg
WAGE LOSS - compensation fa the victm who lost wages due to crime related 
ph 
injuries (Math documentation as outlined in Section 3.) 
SS OF SUPPORT - compensation for the dependent(s) of a deceased victim 
who was employed at the time of the crime. (Attach Cournentaticn as alined 
in Section 4.) 
EXPENSES • payment cc retnticrsenent on oehSt of the victim for cnme-retaed 
funeral/burial, medical/dente treatment and mental health cornseing expenses: 
as well as aesoiptions, eyeglasses, dentures, ons prosthetic &Ake lost 
damaged, or required because of 
cone. 
(Attach termed bels and receip 
treatment/funeral 
O 
FUNERAL/BURIAL 
EDICALMENTAL 
NTAL HEALTWGRIEF 
TREATMENT 
COUNSELING 
in EMERGENCY ASSISTANCE - relmtursement fu dixturnented wage bee and 
out-of-packet a/pauses related b da Came. (Attach receipts.) 
CHECK ALL OTHER TYPES OF 8 ENEFFS YOU ARE REOUESTNG: (Separate claim numbes we be assigned.) 
In PROPERTY LOSS for an Wuh over the age of 60 or enabled adult ,attach 
proof 
disabity pre( to the dab) of nine from a physician a the Social Security 
Administraton) who suflered the loss of tamable serSOna: property, as the restl...

Section 2. Referral Source Information 
Individuals who assisted with or filled out any sections of this application are required to provide referral information below. By signing this applicatior, the victim/applicant 
affirms that all information provided is true and correct, and thus. al sections should be reviewed before the application is signed. (Treatment providers can request 
training on the Victim Compensation Program. which is recommended prior to becoming a referral source.) 
MME OF PERSON ASSISTING WITH APPLICATION 
I EMAIL 
past first mimic) 
ADDRESS 
hAME OF AGENCY/ORGANIZATION 
AGENCY ORGANZATIONS ADDRESS 
(address. city, state, zip code) 
Section 3. Disability or Lost Wages Information 
Men westing ceneersatcrfor bst %vars.tech a copy ofyour ray stub or conics staterrynt atiich 'decrees you eTploinert stale WO wages ate tee d the CAM V)0ll ae Semple* 
or voider a trtiyrnenter, attach a spay of yet blest barna tax ream aril apckabe MS schedule tarns. If mot than 5 work days were meted as a rasa d the crime Malta &dors bear 
wtich erased you kr tag abseret When leclAstril dsatilY COMPenSaf011, alath a dactyls letter neon speaks each cite related penmen( cisabity rang exoreIng bleanest:an lAeckal 
AssoParn Gtitlekes ar Sktifia Imparrre7t Patric Gudekes. and favrad &oat SepolykInwasaatcr award leders 
ELEPHQNE
NUMBER
SUPERVISOR'S WE 
liAl.E OF COMPANY/BUSINESS 
le we ban ere In ernotiyar,pkeie mach looms 'heel 
CONPAINY ADDRESS 
Iaddress. city state, zip code) 
IS WAGE LOSS COVERED BY INSURANCE? 
LI YES 
IS WAGE LOSS COVERED BY WORKER'S COMPENSATION? I-1"° 
YES 
TELENCINIE
WEER 
)
NIJ 
IS VICTIM DISABLED AS A RESULT OF THE CRIME? 
n 
YES 
I I NO 
n NO 
Section 4. Loss of Support Information or Grief Counseling Information 
'ndicate the narre(s) and date(s) of birth of the deceased viaim's surviving spouse, parent, s bang, or chid. For bss of support attach a copy of the deceased victim's 
3t•eSI income tar rein and individual earnings statement reemploy...

Section 7. Crime Information 
This section must be completed and proof of Crime (such as a law enforcement report a charging affidavit) must be attached. Failure to submit proof of crime wit result in 
your application not being processed or your claim being denied. 
NAME OF LAW 
DATE OF 
CRIME 
I DATE REPORTED TO LAW 
ENFORCEMENT AGENCY 
ENFORCEMENT AGENCY 
WAS THE CRP& 
j
 
REPORTED TO LAW ENFORCEMENT WITHIN 72 HOURS? 
YES 
ONO 
If no. please explain. (II no. failure to provide an acceptable explanation in this section will result in a denial of beneib.) 
IS THE APPLICATION AND LAW ENFORCEMENT REPORT BEING SUBMITTED WITHIN ONE YEAR FROM THE DATE OF CRIME? K YES 13 NO 
If no, please explain. (Please be advised that most benefits apply to treatment losses suffered within one year from the date of crane. with sane exceptions for minor wan 
II no. Mime to Monde an %Made explanation in this seams MI result n a denial of bonen.) 
TYPE OF CRIME AS SPECIFIED 
ON THE LAW ENFORCEMENT REPORT 
NAME OF LAW 
ENFORCEMENT OFFICER 
NME OF ASSISTANT STATE ATTORNEY 
HANDLING THE CASE Of applicatle) 
LAW ENFORCEMENT 
REPORT NUMBER 
Section 8. Eligibility Requirements 
NAME OF OFFENDER 
Nlmoitin) 
STATE ATTORNEY! 
CLEW OF COURT CASE NUMBER (if appicable) 
Additional qualification criteria. deadlines, and exceptions not listed may apply. 
Victim Compensation (VC): The victim must cooperate fuly with law enforcement officials, State Attorneys Office, and the Attorney General's Office. The clime 
must be reported to law enforcement within 72 hours, unless there is good cause for delayed reporting. The claim must be filed Within one year after the date 
of the crime or within two years when there is good reason for not fling within one year. Exceptions for filing time requirements apply to victims who are minors. 
The victim must not have engaged in an unlawful activity or contributed to the situation that brought about his or her own injury or death. The victim must have 
suffered a phys...

PLEASE READ CAREFULLY AND SIGN THE FOLLOWING CERTIFICATIONS 
Section 9. 
CONFIDENTIALITY: If you are Ire victim of a sexual battery. aggravated chid abuse. aggravated stalking, harassment, aggravated battery, or domestic 
violence. you have the rignt to have information about your home address and telephore number, employment address and telephone number, and your 
personal assets, kept confidential for a period of five years. If you are the victim of any of these crimes, please mark one of the following statements. Your 
response will not affe the processing of your claim. 
I want the information to be confidential 
O 
I do NOT want the information to be confidential 
SERIOUS FINANCIAL HARDSHIP: I certify that I have a senous financial hardship because of crime-related expenses that cannot be paid by any other 
source. 
PROPERTY LOSS CERTIFICATION: I eerily that the property in question belonged to the victim: that this loss adversely affects the victim's quality of life: 
that there is no other source of reimbursement for this loss; and that replacement of the prope-ty would cause the claimant a serious financial hardship. 
RELEASE OF INFORMATION: I give permission to any hospital, doctor. dentist, mental health counselor, or other treatment provider, bankng triStrtution, 
social service agency, law enforcement agency. corrections agency, state attorney's office, inssance carrier, attorney or employer to give out information that 
is requested concerning any treatment rendered, employment Insurance thrd-party payer, or law enforcement nvestigative information to the Department 
of Legal Affairs for use in processing my dom. I give permission lo the Department to release information about the status of my claim to any treatment 
provider, law enforcement agency. or state attorney's office. 
SOCIAL SECURITY NUMBER DISCLOSURE: The Bureau cf Victim Compensation collects and uses Social Security numbers for the purpose of performing 
mperatve duties and responsiNifiesw...

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Surrounding text: THIS INFORMATION IS C TED FOR FEDERAL REPOR OR

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Surrounding text: “IM: Must be signed and dated by the victim if filng as a competent adu d Name: rue anc