Designing a Victim Services Intake Form for Multiple Funders

A good victim services intake form captures six categories of information: identity, safe contact information, incident, immediate needs, demographics, and consent. The structure is built funder-first, so the same form satisfies VOCA, VAWA, FVPSA, and HUD reporting requirements without asking your survivors the same questions twice. Personally identifying information stays separate from the data you send to funders, because federal law requires it. Every demographic question is optional, with "Prefer Not to Answer" always as a choice, asked in wording that respects the survivor.

This is the kind of intake form StriveDB was built to support, and the rest of this article describes how it works.

Why intake forms are harder than they look

If you run a domestic violence shelter or a rape crisis center, you have probably been here. The intake form on your desk was built one funder at a time. A new grant came in, fields got bolted on. A few years later, the form does not really align with any single funder, and it asks survivors questions in an order that came from a compliance officer, not from an advocate.

That is the usual starting point. Three things make this harder than building an intake form for any other social service.

First, the conversation happens with a survivor in crisis. Every minute the intake takes is a minute the survivor is asked to relive what happened. The form has to do its work efficiently and humanely.

Second, the federal funders are genuinely different from each other. Most centers touch four streams: VOCA, VAWA (the STOP and SASP grants administered by the Office on Violence Against Women), FVPSA, and HUD Continuum of Care funding. Each has its own reporting cycle, its own categories, and its own definitions of who counts and what counts. We will get to those differences in the next section.

Third, the law is strict. VAWA, FVPSA, and VOCA all prohibit sharing personally identifying information for federal reporting. Not even encrypted. Not even when a federal report asks for it. Your reports must be aggregate, which means counts and percentages, never individual records. That single rule shapes everything about how a good intake form is built.

The result, for most centers, is forms that fail in three ways at the same time. They violate funder confidentiality without their authors realizing it. They produce grant reports that need hours of hand-cleaning every quarter. And they ask survivors demographic questions in ways that compound the trauma of the day they came in. That is fixable.

What every victim services intake form should capture

A complete intake form captures information in six categories. Each one earns its place.

Identity. Name, aliases, date of birth (with an "estimated" flag for survivors who do not know it exactly), and a system-generated case number. Aliases matter because survivors using a different name for safety reasons are common. The form should accept that without flagging it as suspicious. One subtle but important rule: do not require a legal name as a condition of service. VAWA does not allow it. If a survivor wants services without giving you her legal name, you must serve her.

Safe contact information. Phone numbers and email addresses, each one tagged with whether it is safe to contact. Whether voicemail is safe. Whether messages can be left. A mailing address with an explicit option for a safe address that differs from where the survivor sleeps. Best time to call. These fields are what keep an advocate from accidentally telling an abuser that their partner is reaching out for help.

Incident. Date, location, and a description of what happened in the survivor's own words. A multi-select for types of violence or abuse, using categories that map to the funder reports you have to produce. Whether a police report was filed and a case number if so. Relationship to the assailant if disclosed. The survivor's own description matters. The legal categorization happens later, in the database, where staff map her words to the categories the funder asks for.

Immediate needs. Safety plan status. Shelter need. Medical need. Legal need. Whether there are children in the household and how many. Pets, because pet protection is a known barrier to leaving. This section is operational. It tells the advocate what to do next.

Demographics. Race and ethnicity. Gender identity and sex. Age. Sexual orientation. Disability. Language preferences. Veteran status. Tribal affiliation if applicable. The wording of these questions matters more than most centers realize, which is why a full section of this article is devoted to them. Survivors are not required to answer these questions to receive services. Period. Every field must have a "Prefer Not to Answer" option.

Consent and confidentiality. A plain-language explanation of what the program will and will not share, before the survivor is asked to disclose anything. Explicit consent for service delivery. A separate, optional consent for limited information release. And explicit documentation of the survivor's right to decline any data-collection question without affecting the services she receives.

What does not belong on a standard intake form: Social Security numbers, immigration status, and detailed criminal history of the survivor. Collect any of these only when a specific grant requires it, and even then, in a separate consented module. Collecting them by default creates exposure that VAWA's confidentiality rules prohibit, and most centers do not need them for the work itself.

One intake form, four federal funders

The article's central idea is simple: an intake form is not a funder report. An intake form is a structured record of a conversation. The same record, stored well, lets the database produce many different funder reports, in whatever shape each funder wants.

That principle is what makes a multi-funder intake possible. Collect data once, in the most inclusive way you can. Map to the funder's categories at report time, inside the database. Your survivors answer each question once. Your reports come out clean.

The four funders, side by side

Three differences in this table cause more multi-funder headaches than any others.

The cycle gap. VOCA wants a report every three months. FVPSA wants a report once a year. Your database needs to keep both rhythms in mind, so the data that goes into a quarterly VOCA report can also roll up into an annual FVPSA report.

The scope gap. VOCA only counts services paid by VOCA. FVPSA counts every DV service your center provided, whether FVPSA paid for it or not. The same survivor can be in your FVPSA count but not your VOCA count, or in both. The database has to know which services were paid by which funder, on every record, to produce both reports correctly.

The sex and gender gap. The current VOCA form accepts only Male, Female, Not Reported, and Not Tracked. The current FVPSA form is more inclusive: Women, Men, Not-specified/Other, plus a separate count of survivors who self-identify as LGBTQ. The intake form should ask gender identity inclusively, and the database should map to whatever each funder accepts.

This is exactly the kind of complexity StriveDB was built to handle. Our reports module produces VOCA, VAWA, and FVPSA reports from the same underlying intake, with funder-specific category mapping handled inside the system so your staff is not doing it by hand.

The confidentiality firewall

Aggregate-only reporting is not a preference. It is the law.

The Violence Against Women Act, the Family Violence Prevention and Services Act, and the Victims of Crime Act all prohibit grantees from sharing personally identifying information for federal reporting purposes. The rule applies even if the information is encrypted. Even if a federal form asks for it. And VAWA also prohibits requiring a signed release of information as a condition of service: a survivor can refuse to consent to any information sharing and still receive every service your program offers.

The published guidance most centers rely on for this comes from Tech Safety, the Safety Net Project at the National Network to End Domestic Violence (NNEDV). Their "Confidentiality in VAWA, FVPSA, and VOCA" document explains the rules in plain language. The architectural takeaway, for an intake form: the database has to keep personally identifying information separate from reporting data, with role-based access controls so the staff running grant reports cannot see PII, and so the PII never reaches an external system.

StriveDB was built around this principle from the start. Role-based access controls let you separate volunteer access from clinical access from administrative access. A restricted-client flag narrows visibility of high-risk records to a small group of users. Reports are generated as aggregates, never as exports of individual records. The firewall is in the architecture, not in policy.

A note on small-cell suppression

Aggregate reporting is not automatically anonymous. In a small service area, single-cell demographic counts can identify a survivor by inference. If your county has one Native American shelter resident this quarter, the aggregate "1" identifies her. The federal regulation at 45 C.F.R. § 1370.4 explicitly contemplates this for FVPSA reports. Good practice is to suppress small cells at report time, when the aggregate itself becomes identifying.

The intake form does not need to know about cell suppression. The database does. StriveDB handles cell suppression at report time, so your staff does not have to remember to do it manually.

How to ask the questions: trauma-informed intake

The form is not the intake. The form is a structured record of the conversation. The conversation is the intake. That distinction matters because everything about how a form is designed should serve the conversation, not the other way around.

The framework most centers use as a starting point is SAMHSA's six principles of a trauma-informed approach, first published in 2014. The six principles are safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and voice and choice, and cultural, historical, and gender awareness. Here is what five of them look like applied to the design of an intake form. (Peer support is harder to design into a form; it shows up in how advocates work, not in form fields.)

Safety. The advocate confirms the survivor is in a safe space before the form starts. Nothing is sent to the survivor's device, email, or phone without first confirming that the channel is safe to use. Any online form the survivor completes should include a quick exit button that closes the page instantly and clears the browser history if someone walks in. Phone numbers and email addresses are flagged for safe-to-contact status per channel. The form supports completion across multiple sessions, with Save Draft preserving partial data, so the conversation can pause and resume.

Trustworthiness and transparency. Consent is informed when the survivor actually understands what she is agreeing to. The consent form is in the survivor's language, written plainly. She knows what the form is for, where the data is going, and what is mandatory before being asked to disclose anything. The right to refuse any question, with no impact on services, is documented on the form itself, not buried in a policy somewhere.

Collaboration and mutuality. The advocate offers before asking. What the program can help with is described first. The survivor describes what happened in her own words. The legal categorization happens later. The form does not ask the advocate to play detective to fill in checkboxes.

Empowerment, voice, and choice. "Prefer Not to Answer" is available on every demographic field. Optional fields look optional, with no red asterisks. The survivor sets the pace.

Cultural, historical, and gender awareness. Picklists reflect the community served. Gender identity options are inclusive. Tribal affiliation is captured as a separate field from race. Language preferences are captured early so the rest of the intake can happen in the survivor's preferred language.

StriveDB supports all of these patterns out of the box. Quick Exit is always visible. Safe-to-contact flags are on every phone and email field. Save Draft works at every step of intake. Picklists for gender, race, ethnicity, and tribal affiliation are tenant-configurable, so your center sets the wording that fits your survivors.

An intake form is not a screening tool

One nuance worth naming. The most rigorous evidence reviews of universal IPV screening, including the Cochrane systematic review of screening in healthcare settings (O'Doherty et al., 2015) and a 2022 review of trauma- and violence-informed care in Current Epidemiology Reports (Mantler et al.), have consistently found that structured screening questions at intake do not, on their own, produce better outcomes for survivors. The intake form is not a screening tool. It is a structured record of a conversation an advocate is already having with someone who has identified that she needs help. That distinction shapes how every question is worded. The form does not ask "Do you feel unsafe at home?" The form records what the survivor has told the advocate, in the survivor's own words, after the advocate has built enough rapport to ask.

How to collect the data: paper, in-office device, or survivor's phone

Before you decide what to ask, decide how you are going to ask it. The way the data gets collected matters as much as the questions on the form.

The most important principle is the one we already touched on: intake is a conversation, not a stack of paperwork. The advocate is there to listen, to offer, and to take notes on what the survivor shares. Handing a survivor a clipboard and walking away, or pointing her at a kiosk to "fill it all in" before someone meets with her, is not trauma-informed intake. It is paperwork triage. The survivor came in for a conversation; the form is the byproduct.

With that as the frame, there are three common ways to capture the data, in order of how strongly we recommend them.

Advocate-led, in-office, with the advocate entering the data

This is our default recommendation. The advocate sits with the survivor, has the conversation at the survivor's pace, and types into the database as they go (or writes by hand and enters later). The survivor is not staring at a form; she is talking to a person who is helping her. The advocate can pause when the survivor needs a moment. Optional fields stay genuinely optional, because the advocate can move past them without making the survivor say "skip." Trauma responses such as fragmented memory or going quiet are met by a human, not a progress bar.

Survivor-completed in-office, on an agency device

When a survivor prefers to fill out the form herself, or when an advocate's time is constrained, the next-best option is to hand her an agency-owned tablet or laptop in the office. She fills out the form in a private room. The advocate checks in periodically, answers questions, and reviews the answers with her at the end. The device never leaves the agency.

This approach preserves the survivor's autonomy and keeps the privacy envelope inside the agency. The browser history, the form data, and any cached information all stay on a device the agency controls.

Survivor-completed on her own device

The third option is a link or QR code she can fill out on her own phone or laptop. This is the most accessible option in some ways and the most dangerous in others. The risks are real and specific. If an abuser uses the survivor's phone, he can see her browser history. If the abuser monitors the device with spyware (which is more common than most centers realize), he can see her activity in close to real time. A form open in a browser tab can be discovered. A confirmation email landing in her inbox can be read.

We built a feature for survivors who do want to complete forms on their own devices. After the survivor submits, the system attempts to clear the browser history for the intake session and routes her to a neutral destination. The goal is to leave as small a footprint as possible on the survivor's device.

We built it because some survivors do not have a safe in-office option, and because giving them no option at all is worse than giving them a carefully built one. But we still do not recommend it as the default. The safer choice is an agency device in an agency office, every time it is possible. (We have written separately about our approach to survivor safety when survivors interact with our software directly.)

The thread through all three approaches is the same. The advocate is in the room, having a conversation. The form serves the conversation. Technology can help the survivor express herself or save the advocate time, but it does not replace the relationship. A survivor in crisis does not need a better form. She needs a person who is actually listening.

How to ask about gender, race, ethnicity, and other sensitive demographics

The most useful principle for the demographic section of your intake form is the one privacy professionals call data minimization. Collect what your funders require. Collect what your center actually uses to deliver better services. Make everything else optional, or do not ask at all.

The reason matters. Every additional field on a survivor-facing intake form is another question she has to answer in a hard moment. Every additional record in your database is another record that could be subpoenaed, breached, or seen by the wrong staff member. The case for collecting more demographic data has to be made affirmatively, not assumed.

What your funders require

The federal funders most centers serve set the floor. Below that floor, you do not have much choice.

VOCA requires race and ethnicity, sex (currently a Male/Female/Not Reported/Not Tracked field on the June 2025 form), and age at the time of the victimization, all reported for new individuals served.

FVPSA requires race and ethnicity, gender (Women/Men/Not-specified/Other), age, language services needed, a count of survivors who self-identify as LGBTQ, and a count of youth ages 13 to 17 receiving services for teen dating violence.

VAWA STOP and SASP reports collect demographics in aggregate; the specific categories depend on the grant.

HUD's HMIS Data Standards specify their own categories for any HUD-funded program.

Anything beyond what your funders ask is your center's choice.

Centers with state-level VOCA pass-through, county victim assistance funds, or foundation grants face the same coordination problem at smaller scale. The categories may be different, but the principle is the same: collect once at intake, aggregate to each funder's categories at report time.

Race and ethnicity

Every federal funder requires race and ethnicity, so every center has to collect it.

The federal standard changed in 2024. The Office of Management and Budget issued its first major revision in twenty-seven years, called Statistical Policy Directive 15. The new standard requires a single combined question on race and ethnicity (instead of two separate questions), and adds Middle Eastern or North African as a distinct category. Federal agencies have until March 2029 to fully comply.

For a 2026 intake, the inclusive approach is the new standard. One combined question. Seven minimum categories: American Indian or Alaska Native; Asian; Black or African American; Hispanic or Latino; Middle Eastern or North African; Native Hawaiian or Pacific Islander; White. Survivors can select all that apply. Detailed sub-categories are available for survivors who want them.

Tribal affiliation is collected as a separate field, not folded into race. Survivors who are members of federally recognized tribes deserve a dedicated place to record that.

At report time, the database aggregates. A survivor who self-identifies as Hispanic and Black appears in VOCA's Multiple Races count and in FVPSA's Unknown/Other count. The intake field stays as the survivor filled it out. The funder category is computed.

Gender identity

Our recommendation is to collect gender identity as a single field with inclusive options, and to skip the question about sex assigned at birth. Few victim service centers collect sex assigned at birth, and most do not have a service-delivery rationale for it. The two-step method (sex assigned at birth plus current gender identity) appears in clinical research and health-care settings, but it is not standard sector practice for victim services intake.

One legitimate exception is worth calling out. If your center provides medical or forensic services where the survivor's sex assigned at birth is clinically relevant, such as a Sexual Assault Nurse Examiner (SANE) exam, an STI screening, or contraceptive counseling, the question may need to be asked in that medical context. Even then, most centers do not document this in their victim services database; it is captured in the clinical record and stays there.

The gender identity options that work well in practice include Woman, Man, Non-binary, Transgender man, Transgender woman, Genderqueer, Two-Spirit where culturally appropriate, Other, and "Prefer Not to Answer".

At report time, the database maps to whichever funder category applies. VOCA accepts Male and Female. FVPSA accepts Women, Men, and Not-specified/Other. The intake field stays as the survivor filled it out.

Sexual orientation

Many centers do not collect sexual orientation on their standard intake. The federal funders do not require it as a field, though FVPSA requires a count of survivors who self-identify as LGBTQ+. That count can usually be captured with a single yes/no question (something like "Do you identify as LGBTQ+?" with a "Prefer Not to Answer" option), without asking the survivor to disclose her specific orientation. Many centers also collect LGBTQ+ identification as an optional barrier-to-service field, alongside fields like language access and disability, which is how StriveDB ships it by default.

If your center has a service-delivery reason to collect sexual orientation in more detail, for example because you provide LGBTQ-specific programming or want to document service patterns, the Fenway Institute publishes recommended option lists. If you do not have that reason, the data minimization principle suggests not asking.

Disability and language

These two fields are different from the others, because they often affect what services your center can deliver. A survivor who is deaf or hard of hearing needs interpretation. A survivor whose preferred language is not English needs language access. A survivor with a mobility impairment may need specific shelter accommodations.

Most centers collect these as functional service-need fields, with multi-select options for disability and a language picklist plus free-text. Both stay optional, with "Prefer Not to Answer" always as a choice, but they tend to be filled in because the survivor wants the services they make possible.

When centers choose not to collect

Some victim service organizations have moved toward minimizing the demographic data they collect on survivors, particularly around gender identity and sexual orientation. The reasoning takes a few forms. Detailed demographic records can be subpoenaed, breached, or accessed by hostile actors, and data that was never collected cannot be released. The federal funding environment has also shifted: in January 2025, an executive order directed federal agencies to stop recognizing transgender, nonbinary, and intersex identities, and the Williams Institute documented the removal of sexual orientation and gender identity questions from approximately 360 federal data collections in the year that followed. Some national organizations, including NNEDV and NSVRC, have scaled back LGBTQ-related content on their public-facing resources. Centers concerned about their own funding have begun to ask whether the safest data is the data they never collected.

Other organizations have continued to recommend collecting this data, arguing that demographic records are what allow centers to document disparities, secure funding for marginalized populations, and demonstrate to funders that LGBTQ survivors are being served. The National Center on Domestic Violence, Trauma & Mental Health and the National Coalition of Anti-Violence Programs have continued to publish guidance for serving LGBTQIA2S+ survivors that depends on this data being collected somewhere.

Both positions are defensible. The choice is your center's, informed by the community you serve, your funder mix, your state's confidentiality protections, and your own assessment of the risks. Whatever you decide:

• Collect only what your funders require and what your center actually uses.
• Every demographic field beyond what funders require should be optional, with "Prefer Not to Answer" always as a choice.
• The choice should be documented in writing and reviewed at least annually as the funding environment evolves.
• Survivors should know what is being collected, why, and where it goes, before they answer any question.

StriveDB's picklists for gender, race, ethnicity, sexual orientation, and tribal affiliation are configurable at the center level. The architecture does not assume any particular policy position; it gives your center the controls to decide what to collect and act on its own judgment.

Common mistakes we see

Three patterns show up across the intake forms centers send us when they are considering switching databases.

1. Demographic fields marked required. Every demographic field should be optional, with "Prefer Not to Answer" always as a choice. Required demographic fields violate trauma-informed practice and, in some cases, federal confidentiality rules.

2. The funder's data template copy-pasted into the survivor-facing form. The funder template is a reporting structure. The intake is a conversation. They should not look the same.

3. PII not separated from reporting data. Even if every field is correct, if the staff running grant reports can see Social Security numbers and home addresses, the confidentiality firewall is broken.

How StriveDB approaches this

We built StriveDB because we kept watching centers like the Rape Crisis Center of Central New Mexico struggle with the same intake-form problem, and we believed software could solve it. Every principle in this article is part of how StriveDB works.

Intake captures data once. The case intake wizard walks an advocate through identity, demographics, incident, circumstances, and consent in a survivor-friendly order, with Save Draft at every step.

Reports come out clean because we apply the collect-once-count-many-ways principle at the database layer. VOCA quarterly, VAWA, and FVPSA reports are built in. Custom reports for state, county, and private funders are available on our Team and Premium plans, built by our team for each center's specific funder mix.

Confidentiality is in the architecture. Role-based access controls, a restricted-client flag for high-risk survivors, safe-to-contact flags on every phone and email, a Quick Exit button on every page. Aggregate-only reporting that satisfies federal requirements without exposing individual records. More on our security posture here.

Frequently asked questions

Sources

1. National Network to End Domestic Violence: Listening to Survivors: Essential Steps for the Intake Process.
2. National Network to End Domestic Violence (with Collaborative Solutions): Comparable Database 101.
3. Tech Safety / Safety Net Project at NNEDV: Confidentiality in VAWA, FVPSA, and VOCA.
4. Office for Victims of Crime: Victim Assistance PMT User Guide (2025).
5. Office for Victims of Crime: Subgrantee Data Report (June 2025).
6. Administration for Children and Families: FVPSA Performance Progress Report forms (2024-2027 cycle).
7. Administration for Children and Families: 45 CFR Part 1370.
8. Office on Violence Against Women: VAWA STOP and SASP performance reporting via VAWA MEI.
9. Substance Abuse and Mental Health Services Administration: Concept of Trauma and Guidance for a Trauma-Informed Approach (SMA14-4884).
10. Federal Register: Revisions to OMB Statistical Policy Directive No. 15 (March 29, 2024).
11. National Academies of Sciences, Engineering, and Medicine: Measuring Sex, Gender Identity, and Sexual Orientation (2022).
12. National LGBTQIA+ Health Education Center at the Fenway Institute: Ready, Set, Go! A Guide for Collecting Data on Sexual Orientation and Gender Identity.
13. Williams Institute, UCLA School of Law: Removal of Sexual Orientation and Gender Identity from Federal Data Collections, January 2025 to January 2026 (February 2026).
14. National Center on Domestic Violence, Trauma & Mental Health: Supporting LGBTQIA2S+ Survivors.
15. National Coalition of Anti-Violence Programs: published reports on LGBTQ and HIV-affected intimate partner violence.
16. O'Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A: Screening women for intimate partner violence in healthcare settings, Cochrane Database of Systematic Reviews (2015).
17. Mantler T, Veenendaal J, Wuerch MA: Trauma- and Violence-Informed Care: Orienting Intimate Partner Violence Interventions to Equity, Current Epidemiology Reports (2022).