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1. Reporting Category (must select one)
Crime is not in VOIAC
More information on a crime already in VOIAC
Corrected information on a crime already in VOIAC

2. Crime Data (at least one check box required.)
Check all categories as applicable. there may be multiple categories. "Seriously injured" is relative but assumes a lenghty hospitalization and/or recovery or a permanent disability.

Molested
Sexual assault including rape
Seriously injured in automobile accident
Killed in or as a result of an automobile accident
Seriously injured in physical assault
Killed in or as a result of a physical assault
Gang Rape
Gang crime or multiple perpetrators
Crime or Perpetrator involved with drugs
Crime involved a kidnapping
Crime involved home invasion
Crime involved a Mexican truck or illegal alien truck driver
Crime or Perpetrator terrorist related

3. Date of Crime
If day and/or month is uncertain or unknown, leave blank and check the "Month and/or day unknown" box.
Month:   Day:    Year (required):           Month and/or day unknown:

4. Location of Crime
City:   County:   State/Territory (required):

5. Victim Information
If there are multiple victims for the same crime enter each victim individually. The "multiple victims" submission button at the bottom of the form will duplicate the filled out form for another victim, with the exception of the information in sections 5 and 8, allowing easy reporting of multiple victims.

First Name  (use "Jane" or "John" "Doe" for sexual crimes)
Last Name    

Sex:
Age: (round off to the nearest year. For babies less than 6 months use "0")

Residency:   
State/Territory: (required but use the blank if unknown)


Race or Ethnicity: Caucasian Black Asian American Indian Hispanic Other

Victim is part of law enforcement

6. Perpetrator Data
First Name Middle Name Last Name

Sex
Age:

Nationality (select one)    
nationality unknown but most likely an illegal alien
nationality unknown but confirmed as an illegal alien

Arrest Status (required):   

Suspected/Wanted
Charged
Convicted/Died in Crash

Perpetrator:   
 Had been previously ordered deported but did not get deported
 Had been previously deported but returned
 had prior felony charges or conviction
 was DUI/DWI when accident occurred
 was DUI/DWI when accident occurred and had one or more prior DUI/DWIs
 was a hit-and-run driver.

Multiple Perpetrator Information:
Please enter any aliases here. If there were multiple perpetrators, please provide data on the additional perpetrator(s). This information is for reference only and can not be searched or sorted on.


7. Crime Description
Provide a title line of the crime, a summary description of the crime, and additional information on the victim(s), the crime, and the perpetrator(s) as necessary. Note the character limitations. Spaces count as a character.

Title line of crime. (required) 100 character limitation


Details of the crime. (required) 5000 character limitation.
NOTE: use of copyrighted material must give credit to original source.

8. Crime Documented or Reported by...(required)
Crimes must be documented. For reported crimes, include publication date, news agency and location if done by a broadcasting media, title of article, and the reporter's name, if available. Put the Internet link in the following line, even if the link went dead after you captured it. Include police and court report numbers, if known. Thus the generic documentation format is:

23JUNE08, Rocky Mountain News, Denver, Colorado
Illegal Alien Convicted of Crime, by Bill Jones
http://www.asdfw34tt434t34t.com



9. Pictures

Images must be in a JPG format with a maximum size of 640H by 480V pixels. When submitting multiple
victims for the same crime, upload all perpetrator and "other" pictures in the first submission, only adding the new victim's picture in each subsequent submisson.


Picture of Victim:             
Picture of Perpetrator 1:    
Picture of Perpetrator 2:    
Additional Picture:           
To mail a photograph, go here for instructions.

10. Submitter's contact information
(Not required to submit the form. Only the by-line will be displayed and contact information is only required and used as noted below. The By-Line is for your publishing name, handle, website, or organization and is for recognizing the commitment and diligence of volunteers, concerned citizens, and patriots doing the job the MSM and GOVT should be doing but aren't.)

Byline:        max 50 characters
Name:         max 50 characters
Telephone:   in format '123-456-7890'
E-mail:        max 50 characters

I am interested in receiving periodic information on VOIAC. (requires e-mail address.)

I am interested in becoming involved in VOIAC. (Requires Name and E-mail and/or Telephone)

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