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Was the assault committed by someone who the potential client was not in a romantic relationship with? (i.e. family member, boss, co-worker, teacher, coach, classmate, friend, acquaintance, etc.)

Yes No

Sexual assault can impact every part of a survivor’s life, from their job or education to their housing to their reputation. Is the potential client facing any of the following issues since the assault?

• Fear of encountering the perpetrator in day-to-day life
• Eviction or unsafe living conditions
• Identity theft, invasion of privacy, or harassment on social media
• Absence from work, loss of income, or denial of unemployment benefits
• Immigration issues
• Family law issues such as child custody, parenting time, child support, and divorce
• Reduced credit score or wage garnishment
• Criminal convictions
• Human trafficking
• Problems at school such as exposure to the perpetrator, harassment, or a lack of resources

Is one of these rights at stake?

Yes No

At the Survivor Law Clinic, we understand it can be difficult to know what resources are available and what issues have a legal remedy. If you think any of the these issues might apply to the potential client, please fill out this brief form so we can learn more about the situation and if we can help.