Cult Victim Support Form | Families Against Cult Teachings

___________________________________________________________________________________

If you or someone you know is in need of victim support services, please fill out our form as thoroughly as possible. All information sent to F.A.C.T. will be kept strictly confidential.

If it’s an emergency, please contact 911 immediately.

{"result":"fail", "msg":"Oops! An Error Occurred(001)"}

YOUR INFORMATION:

Your Name:

Email Address:

Phone Number: (no dashes or spaces)

Primary Address:

VICTIM INFORMATION:

Name of person you're seeking help for:

Age:

Sex:

Your relationship to this person:

CULT GROUP INFORMATION:

Name of Cult Group or Church:

Date recruited:

Where:

Please describe the situation:

What are the reasons given why he/she has joined this group?

Has the individual ever expressed any doubts or difficulties as a member to anyone?

VICTIM'S BACKGROUND:

Educational Background and Interests:

Special hobbies and talents:

Religious background (and history of religious involvement):

Employment experience (include what jobs, where, how long and reason for leaving):

Previous education and career goals:

Does the person have any physical health problems:

Has there been any prior drug use, if yes, please explain:

Describe the person's social, emotional and psychological well being:

Describe the individual's activities and state of mind just prior to joining:

Is the individual still in touch?

VICTIM'S FAMILY BACKGROUND:

Father's name and occupation:

Mother's name and occupation:

Marital status:

Siblings:

Which person has been closest to the individual?

Describe the family environment before the individual joined this group or cult.

Detail the significant relationships or lack of relationships.

Have there been any estrangements that have had an impact on family members?

Has alcoholism/ drug use/ violence/ sexual abuse/ adoption affected any member of family?

Describe any other significant relationships.

Do you have family and close friends that are willing to help if need be?

COURSE OF ACTION:

Describe how each family member has reacted to the cult involvement.

Describe what action you have taken until now.

Describe any future plans or ideas you have about how you can resolve this:

Is there anything else that we should know or you would like to tell us?

What is 2 + 3 ?

Thank you for filling out the form.

If you have any supporting evidence you would like to share, please send it to ObscureMyEmail

flexible Families Against Cult Teachings

Tweet

Families Against Cult Teachings and Abuses

Education & Awareness | Victim Support | Cult Group Investigation

First Name:

Email:

Families Against Cult Teachings and Abuses

Education & Awareness | Victim Support | Cult Group Investigation

First Name*: Email*:

First Name:

Email: