Online Live Victim Impact Panel Registration

Live Online Survivor Speakout Victim Impact Panel – Accepted Nationwide
You cannot attend online with your cell phone!
Register by completing form below.

Times are EST (Eastern Standard Time) Space is limited.

Read the full guidelines to attend ONLINE

Survivor Speakout Victim Impact Panels are accepted by court systems nationwide. Survivor Speakout online is a 2-hour live online presentation, not a recorded class, and there is no test.

NOTE: You cannot attend online using your cell phone. You must have a reliable internet connection and an iPad, Android tablet, laptop or personal computer to attend a Survivor Speakout victim impact panel online. 

The form below is to request to attend Survivor Speakout Victim Impact Panel ONLINE. Once the form has been submitted you will be directed to a page to pay your $50.00 fee. You will receive a confirmation email after submitting this form. If you do not receive the confirmation email, check your spam/junk folder.

Complete this form to register.

Request the date you would like to attend Survivor Speakout ONLINE LIVE

Date *Choose a date to attend ONLINETuesday, January 14 - 9:45am-NoonThursday, February 20 - 9:45am-NoonTuesday, March 18 - 5:45pm-8pmThursday, April 3- 9:45am-NoonTuesday, April 22 - 5:45pm-8pmTuesday, May 6 - 5:45pm-8pmThursday, May 22 - 9:45am-NoonWednesday, June 11 - 9:45am-NoonTuesday, June 24 - 5:45pm-8pmTuesday, July 8 - 5:45pm-8pmWednesday, July 30 - 9:45am-NoonTuesday, August 12 - 5:45pm-8pmThursday, August 28 - 9:45am-NoonTuesday, September 9 - 9:45am-NoonWednesday, September 24 - 5:45pm-8pmThursday, October 9 - 9:45am-NoonTuesday, October 21 - 5:45pm-8pmThursday, November 13 - 9:45am-NoonThursday, November 13 - 5:45pm-8pm

Your Personal Information

Last Name / First Name *

First

Last

Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Telephone *

Email *

Email

Confirm Email

Your age *Choose one15-1819-2526-3031-3536-5041-4546-5051-5556-6061-6566-7071-7576-8081-8586-9091-9596-100

On what charges were you arrested?

Charge *Choose oneDWIDUIOWIOUIPIMinor in ConsumptionOpen ContainerIllegal possession of alcoholDrug RelatedOther

If you chose 'Other' above, please tell us what you were charged with

Your probation officer

Probation officer *Choose oneAbigail O’BrienAlex RedmanAmber HoffertAndrew LillpopAshley StarlingBetsy SchulerBen NeureiterBrandon FowlerBrian DayBrittany StodghillCaleb LazanoCaleb NanzerCarmen SimsCarol NienaberCaroline CathcartChad BoruffCheryl KochChad KoebckeChad UlmerChantel CloudChristina CandiaCorey WalkerCourtney SacchiniDwight StevensonElizabeth KriegErinn McCluneyFaith EdwardsFaith OliverJamie WodtkeJana SchwindtJesse TuckerJohni TaylorJustin CulpKevin McCleeseKristin UshmanLeah BakerMakayla HuseMalachi TaylorMariah MyersMcKinzee TerryMegan CarusoMegan MorgusonMelody SearsPatrick GillianRebecca ShrockReid RoetheRichard PorterRichard MartinezRonda GibsonShelby WiserStephen OwensSteve RobertsSuzan Shrock-GideonThomas PurkhiserTim MillerZach MinardoMy probation officer is not listed.I do not know my probation officer's name.I have not been assigned a probation officer. I have a diversion agreement.

If your probation officer's name is not listed, enter their name here

Who is the judge presiding over your case?

Judge *Choose oneI do not know my judge's nameThe Honorable Rhett StuardThe Honorable Dan ZielinskiThe Honorable Mark SmithThe Honorable Stephanie Lemay-LukenThe Honorable Charles E. HostetterThe Honorable Robert FreeseThe Honorable David ColemanThe Honorable Lindsay R. WalkerThe Honorable James D. SpencerThe Honorable Maureen T. OwenThe Honorable Bruce E. PetitThe Honorable J. Jeffrey EdensThe Honorable Matt HeadleyThe Honorable Tammy SomersThe Honorable Clayton A. GrahamThe Honorable Amy JonesThe Honorable Ryan TanselThe judge presiding over my case is not listed

If you know the name of your judge, but they are not on the list, enter it here

County information

In which county were you arrested, charged or convicted? *Choose oneI live outside of IndianaAdamsAllenBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushSt. JosephScottShelbySpencerStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitley

If outside of Indiana, list the city and state where you were arrested, charged or convicted

In which county do you live? *Choose oneI do not live in Indiana.AdamsAllenBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushSt. JosephScottShelbySpencerStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitley

If you live outside of Indiana, list the city and state where you live

How did you hear about Survivor Speakout *Choose OneMy probation officerMy attorneyOnline searchOther

If you chose "Other" above, tell us how you heard about Survivor Speakout?

Technology required *

• I understand that I CANNOT use a cell phone, iPad or tablet to attend Survivor Speakout online and that I must use a laptop or personal computer (PC).

Guidelines *

• I have read and understand all of the Survivor Speakout Guidelines to attend ONLINE USING ZOOM

This is a graphic presentation *

• I understand that the Survivor Speakout Victim Impact Panel is graphic in nature dealing with death

PHOTO ID *

• I understand that I will be asked to present my photo ID

English to Spanish translation captioning

• I would like to request translation captioning from English to Spanish when I attend..

Comments/Questions

Submit

Contact Survivor Speakout directly with questions. 317.289.3242