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  Application  
 
 
  Download the file below, read the instructions carefully and fill out the claim application. Also include copies of as much related information (i.e. copies of itemized receipts, bills, insurance statements) as you have.

The more information we have now, the sooner your application can be processed. You can send more itemized bills later as you receive them.

The VCCO will send you a letter when your application is received. If you have not received a letter after four weeks, please call the VCCO. Keep in touch. If you move or if your phone number changes, please let us know.		  
     
 
Application and Instructions
This is a fillable PDF free pdf reader
 
     
  Help with completing this form can be found through law enforcement agencies, your County Office of Victim/Witness Advocacy or by contacting us at 1-877-658-2221.  
     
     
     
     
     
     
     
     
     
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