Survivors of Homicide Support Group Application (Adults)

The Gwinnett County District Attorney's Office Victim Witness Program was created to assist victims and witnesses of crime during their involvement with the criminal justice system. The survivors of homicide support group was created for anyone who has experienced a loss due to a homicide or vehicular homicide.

The sudden or unexpected loss of a loved one can have a tremendous effect on those who knew the victim. Those left behind to mourn are called "homicide survivors" and no amount of justice, restitution, prayer or compassion will bring their loved one back. It is important to understand that grief can look different for everyone.

Death and grief are not openly discussed in American society. It can be very helpful and supportive to meet with others who have experienced similar losses. The survivors of homicide support group will provide a safe environment for children and adults to share their stories as they continue to face the challenges of life after a loved one has died.

We look forward to having you participate in our support group! Please be sure that you complete one application for each individual wishing to participate. This enables us to serve you as individuals. Please fill out the application completely and thoroughly, and verify that you have signed and dated all appropriate releases prior to submitting your application packet. You will be contacted by email within a week of receipt of application. You will then be scheduled for a phone interview and orientation. If you are not contacted within a week, please call the office at (770) 822-8444 to ensure we received your application. If you are not email accessible, please indicate to call.

The Victim Witness program is responsible for maintaining the confidentiality of your application and all family information. Personal identifying information contained in your file will not be released without your prior written consent.

Please complete and submit a separate form for each individual wishing to join.

If you have any questions, please feel free to contact us at (770) 822-8444.

Participant Information
Email is our preferred method of communication with you; please provide a current email address and keep us updated if it changes. If not email accessible, please indicate to call only.
Current Living Situation
Information about the Person Who Died

Please include as much information as you are comfortable providing. This helps us identify the needs and services that best fit your unique loss.

Additional Information

Please help us learn more about you. Feel free to include as much information as you would like. Please attach an additional page if needed.


(Please be specific. Include the name of the person and/or agency, organization or publication that referred you):
Emergency Contact Information (Emergency contact must be someone not in the group)
Application Verification Signature

(Check box to indicate acceptance.)

Artwork, Photographs and Video Images

(Check box to indicate acceptance.)

04/21/2021 11:05 PM
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