VQRP | Victim Services

VQRP

You may or may not need to fill out this form if you do not need to fill out the form please enter the reason below. If you do please continue to fill out the Eligibility Checklist for our VQRP Program.

Use this form to verify that all eligibility requirements have been met. You must answer yes to each question before proceeding to the next question. If the answer to any question is no, eligibility requirements are not met.

Reason For Not Completing Form:
Please scroll to the bottom of the page and click "submit", if you are not completing the rest of this form.

1. Has a crime been committed?:
Yes

No

2. Does it fall into any of the following categories?:
Yes

No

2b. If yes which one?:
Homicide

Attempt Murder

Serious Physical Assault

Domestic Violence

Sexual Assault

Hate Crime

3. The request is being made for an immediate need in the immediate aftermath of the crime for::
Emergency Crime Scene Clean Up

Emergency Home Repairs to Secure Premises

Emergency Transportation

Emergency Child Care &/or Dependent Care

Counselling Expenses

Funeral Expense

The crime has been reported to a Police Service in the province of Ontario and an incident Report has been completed,:
Yes

No

If you answered no to the above question: If unreported to a Police Service, in cases of domestic violence or sexual assault, the crime has been reported to a hospital or community agency providing services to victims of domestic violence and/or sexual as:
The victim resides in the province of Ontario⁮

The applicant is a victim or qualifies to make this request on behalf of a victim.

The request for service was completed nor later than 14 days after the crime was reported.

The expenses are directly related to the impact of the crime identified in the Referral Form.

The applicant has no other financial resources to meet this need.

The applicant has not previously received funds for this offence.

The funds are to be expended in Ontario.

The victim is not charged in the reported occurrence

The expenses will not be covered by any other sources of funding.

Were any needs identified that this program was unable to meet? If so, please list. (i.e. transportation to appointments- doctor, lawyer, counselor):

Reason For Not Completing Form:

Please scroll to the bottom of the page and click "submit", if you are not completing the rest of this form.

1. Has a crime been committed?:

Yes

No

2. Does it fall into any of the following categories?:

Yes

No

2b. If yes which one?:

3. The request is being made for an immediate need in the immediate aftermath of the crime for::

Emergency Crime Scene Clean Up

Emergency Home Repairs to Secure Premises

Emergency Transportation

Emergency Child Care &/or Dependent Care

Counselling Expenses

Funeral Expense

The crime has been reported to a Police Service in the province of Ontario and an incident Report has been completed,:

Yes

No

If you answered no to the above question: If unreported to a Police Service, in cases of domestic violence or sexual assault, the crime has been reported to a hospital or community agency providing services to victims of domestic violence and/or sexual as:

The victim resides in the province of Ontario⁮

The applicant is a victim or qualifies to make this request on behalf of a victim.

The request for service was completed nor later than 14 days after the crime was reported.

The applicant has no other financial resources to meet this need.

The applicant has not previously received funds for this offence.

The funds are to be expended in Ontario.

The victim is not charged in the reported occurrence

The expenses will not be covered by any other sources of funding.

Were any needs identified that this program was unable to meet? If so, please list. (i.e. transportation to appointments- doctor, lawyer, counselor):