Clergy Abuse Victim Resource Form

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The Attorney General’s Office is dedicated to assisting victims of clergy abuse. Upon receiving a submitted form, a representative from the Attorney General’s Office will contact you. A submitted form is confidential and a closed record under Missouri Sunshine Law.

Clergy Abuse Victim Resource Form

Your Contact Information

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Primary Phone Number(Required)

Email(Required)

Additional Questions

Please answer all of the questions below that apply:

Are you a victim?

Yes

No

Are you a witness?

Yes

No

Where did the alleged abuse occur?

When did the alleged abuse occur?

Was the abuse ever reported to the church/diocese?

Yes

No

If so, what year?

Was the abuse ever reported to a law enforcement agency?

Yes

No

If so, what year?

What do you want to report?

BY FILING THIS FORM, I UNDERSTAND THAT: The Attorney General’s office is conducting an independent review for the purpose of public transparency and accountability. The Attorney General is not the primary prosecuting authority for alleged crimes of this nature and in accordance with Missouri law, forms may under certain circumstances be disclosed to appropriate law enforcement agencies. I ATTEST TO THE ACCURACY OF THE STATEMENTS MADE IN THIS FORM.

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Clergy Abuse Victim Resource Form

Clergy Abuse Victim Resource Form

Your Contact Information

Additional Questions