Victim/Witness Notification Program Enrollment Request Form
To enroll in the Victim/Witness Notification Program, complete and submit the registration form below. When you submit this information it will be a secured transmission and remain confidential. The person who victimized you will not know you are being notified and will not have access to your address or telephone number.
As you enter the information, press 'Tab' to move from field to field.
Information about your age and gender is voluntary and will be used for statistical purposes only.
DSHS wants to be able to quickly and reliably contact you prior to the release of the perpetrator from DSHS custody. Please choose the most effective method of notifying you below. In the event of an escape we will contact you by the most expedient means reasonably possible. It is your responsibility to keep us updated on your current address, email and phone numbers.
* Indicates Response Required
Note: If you reject this declaration, you will not be enrolled the Victim/Witness Notification Program. Please contact us at (800) 422-1536 or email email@example.com if you have any questions.