Clergy Abuse Form – Virginia State Police

If you were a victim of an abuser associated with a place of worship or parochial/religious school, or you have knowledge of such abuse, please complete the form provided on this page and click on “submit” at the bottom. The form will be sent directly to and only to the Virginia State Police. Please note that we are not able to comment or provide any information regarding an investigation.

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Your First Name:*

Your Middle Name:

Your Last Name:*

Age*

Please enter a number from 1 to 125.

Street Address Line 1:*

Street Address Line 2:

City:*

State:*

Zip:*

Phone

Was offender a member of the clergy?

Yes

Unknown

City/County/State of Offense (if known):

Offender's Name (if known):

Year Offense Occurred (if known):

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