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  1. What type of violence did you witness or the person you are inquiring about witness?

  2. Are you a Victim?

  3. If you answered "No", what is your relationship to the victim?

  4. What type of assistance do you need?

  5. How did you hear about the Network for Overcoming Violence and Abuse? Please select the referral source:

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  7. This field is not part of the form submission.