Complete those sections that apply, and add any additional sheets.
This document may be completed by a friend, relative, or advocate for the victim.
Write neatly or type.
Document/itemize financial losses, as a result of the crime.
Sign and date the Victim Impact Statement form.
Please return your statement to:
Victim Witness Assistance Program
Office of the Commonwealth’s Attorney
9300 West Courthouse Road, #102
Manassas, VA 20110
Below is a list of suggestions for completing a Victim Impact Statement. Ask the victim/witness program staff or the prosecutor for more assistance in completing the form.
What you should do when completing the form:
- Discuss how you felt while the crime was taking place or the emotional impact this crime has had on your life
- Discuss the physical, psychological, and financial impacts of the crime
- Use specific examples of how the crime has changed your life
What you should not do when completing the form:
- Introduce new evidence not covered at the trial or repeat evidence already presented
- Use derogatory or obscene language in discussing the defendant
Victim Impact Statement (VIS) Forms:
VIS Homicide in Spanish
VIS Form in Spanish
VIS for Parents of Child
VIS for School-Aged Child
VIS Just for Kids
VIS for Teenage victims
VIS for Business