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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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The actions of Mr. Doe have greatly affected my life. Since he committed this crime, I have been unable to sleep at night. I am constantly afraid that someone will break into my home and injure me again.
Impact statements follow a simple formulaI: Describe the issue or problem statement (relevance) in simple terms appropriate for your principal audience. ... Provide an action statement (response). ... Describe the impact (results). ... Who was responsible? ... Your name and contact information.
A concise statement of what outcome the victim would like and the reasons to support this opinion, including support for or opposition to treatment or community service programs. Highlights about the victim. Past accomplishments, hopes for the future, and what the crime has done to change these activities.
Effective impact statements: Provide quantifiable evidence of change or difference the research or program made. Give other evidence, such as testimonials or anecdotes. Realistically project potential benefit for work in progress. Provide only enough detail to be easily understood.
Example: Every morning when I wake up, I have to remind myself that my attacker won't be able to hurt me today. If I don't tell myself that I simply can't get out of bed. Since I was assaulted I have lost the full function of my right leg.