Instructions
 
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

Helpful Hints
 
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
  • VIS Homicide in Spanish
  • VIS Form
  • 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
  • VIS for Business

  • VIS Just for Kids