Request Help From WHOA-KTD

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Being harassed is a terrible experience. You're probably feeling angry, depressed and scared. In order to assist you, we need some information. Please take a deep breath, calm yourself as much as you can, and fill out the whole questionnaire, even if it seems as if it's taking too long. The more information you provide, the better we can help you. If you only give us vague answers, we cannot help you properly and will waste valuable time asking you for clarifications.

If you are over the age of 18, please go to the questionnaire
on the adult division of WHOA.

Before you fill out this questionnaire, please make sure you have read How to Respond to Online Harassment and you're sure that you really are being harassed according to our guidelines.

Be advised that everything you write is confidential, and that WHOA-KTD will not make any representations to anyone on your behalf without asking you first for permission. You are in control here. We'll caution you once more - WHOA-KTD is not related to any law enforcement organization. WHOA-KTD volunteers are not attorneys and do not give legal advice. We cannot promise you that any of our advice will be effective. WHOA-KTD can make no guarantees. We will be offering information based on our experiences with online harassment and cyberstalking.

If you have contacted CyberAngels, SafetyEd or another online organization for help, please do not fill out this questionnaire. We will not accept cases that are currently under investigation by another organization. Duplication of your efforts could impede the course of the investigation or cause legal problems at a later date. It also hampers us and other victims if we are spending time on your case when it's already being taken care of elsewhere. If, however, you've contacted another organization for help and have not heard from them within seven days or they have told you they cannot help you, go ahead and use this form and we'll certainly try to help you.

If You Have Problems With the Form

If you cannot use this form, please copy this text file to a new email, fill in the answers, and send the email to .

Harassment Report Form

What is your full name?

What is your email address?

Please be especially careful here - if you make an error in entering your address, we'll have no way to contact you. Also, please be sure that we can reach you - we have had trouble, for instance, contacting AOL users who have their accounts configured to only accept email from certain senders or other AOL users. If you are using a spam filter or blocker, please make sure that haltabuse.org is an approved domain.

I live in North America.
I live outside of North America.

What do you know about the person who is harassing you? Please provide as much information as possible. If you don't know something, then skip that field.

Harasser's Name:

Harasser's Email address (just one here please):

Harasser's Age:
Under 10
10-15
15-18
Under 18
18 - 30
31 - 40
41 and over
Absolutely no idea

Harasser's Location:
Country:

Province, State or Territory:

Instant Messaging ID of the harasser (list only one please):

This ID is for which IM system?
AOL IM
ICQ
Jabber
MSN Messenger
Yahoo Messenger
Other - give details:

Any other or additional information, such as additional aliases, nicknames, email addresses, web site URLs, instant messaging IDs (with the system identified, please), etc.
Did you have any relationship or contact with the harasser, online or offline, before the harassment began?
None - absolutely no contact prior to the beginning of the harassment
Online acquaintance
Offline acquaintance
Family member
Romantic relationship (marriage, dating, online romance, etc.)
Coworker
Fellow student
Other - please explain below.
Do you know why you (or the kid-teen you are trying to help) are being harassed by this person or persons? Please explain this in as much detail as possible.
Date of first known interaction with the harasser:

Type of first known interaction:
Email (not on a mailing list)
Mailing list
AOL Instant Messages, ICQ, Yahoo Messenger, etc.
IRC/chat rooms
Usenet (newsgroups)
Message board (other than newsgroups)
Web site
Telephone calls
Letters or other physical items delivered via postal mail, UPS, Federal Express or other means
Offline (face-to-face)
Other - please describe:
Date of first harassing communication:

Type of first harassing communication:
Email (not on a mailing list)
Mailing list
AOL Instant Messages, ICQ, MSN or Yahoo Messenger, etc.
IRC/chat rooms
Usenet (newsgroups)
Message board (other than newsgroups)
Web site
Telephone calls
Letters or other physical items delivered via postal mail, UPS, Federal Express or other means
Offline (face-to-face)
Other - please describe:

Other information regarding how the harassment began. Please describe fully and give specific dates.
On what date did you receive the most recent harassing communication?

Type of most recent harassing communication:
Email (not on a mailing list)
Mailing list
AOL Instant Messages, ICQ, MSN or Yahoo Messenger, etc.
IRC/chat rooms
Usenet (newsgroups)
Message board (other than newsgroups)
Web site
Telephone calls
Letters or other physical items delivered via postal mail, UPS, Federal Express or other means
Offline (face-to-face)
Other - please describe:
What forms has the harassment taken? (You may select multiple answers)

Email messages (not on a mailing list)
IRC/chat rooms
Usenet (newsgroups)
Mailing list
Message board (other than newsgroups)
AOL Instant Messages, ICQ, Yahoo Messenger, etc.
Web site
Telephone calls
Letters or other physical items delivered via postal mail, UPS, Federal Express or other means
Offline (face-to-face)
Other - please describe:
Has the harassment escalated since it began? For instance, have the communications become more frequent, or has the content of those communications become more overtly threatening or defamatory?

No
Yes
Have you been threatened with physical offline harm, e.g. violence, kidnapping, rape, death? Include any threats made against members of your family or household or your significant others:

No
Yes

If yes, how were these particular threats communicated to you?

Email messages (not on a mailing list)
IRC/chat rooms
Usenet (newsgroups)
Mailing list
Message board (other than newsgroups)
AOL Instant Messages, ICQ, Yahoo Messenger, etc.
Web site
Telephone calls
Letters or other physical items delivered via postal mail, UPS, Federal Express or other means
Offline (face-to-face)
Other - please describe:

Please give any other details regarding the threats:
Have you (or a member of your family/household or someone who is a significant other to you) been physically attacked by this person? This does NOT include damage to property:

No
Yes

If yes, please give details:

Person attacked:
Self
Other
Both

Date of attack:
Other details:

Was the attack reported to the police or other authorities?
No
Yes

If it was reported, what was the outcome of that report and/or prosecution:

If it was not reported, why not?
Has your reputation been attacked, e.g. have lies been spread about you to others?

No
Yes

Please describe the defamatory statements, including where, how, when and to whom they were made:
Has someone been impersonating you online (forging your name on posts, emails, etc)?

No
Yes

If yes, how?
What material evidence do you have of this harassment? Check off one or more of the following categories below. Remember to keep anything you may receive or know about, on disk and/or hard copy (printed out):

Email messages (not on a mailing list)
Mailing list messages
IRC/live chat logs
Logs of AOL Instant Messages, ICQ, Yahoo Messenger, etc.
Logs of various types of electronic attacks (i.e. Nukes, ICMPs etc)
Usenet (Newsgroup) posts
Message board messages
Hostile web pages
Recorded telephone conversations or messages
Letters/correspondence or other items delivered via postal mail, UPS, Federal Express, etc.
Witnesses who would be prepared to make statements under oath
Other please explain:
Have you reported this harassment to anyone before coming to WHOA-KTD for help?

No
Yes

If so, who?
Harasser's ISP
Harasser's email provider
Forum/Board Moderator
Web Hosting Firm
Someone at your school
Mother, father or other family member
Law Enforcement
Other - please explain:

Please give full details of everyone to whom you have complained or reported, and the outcome of those reports.
Have you sent any communication to the harasser yourself, or made statements about the harasser in a public place?
No
Yes

If yes, please describe. Give dates, type of communication, etc. Consider any email messages, chat or IM exchanges, usenet or forum/board messages directed to or about the harasser, web sites published, etc.
Do you use the following:

Software firewall: No Yes Don't Know
If yes, what software and version:
How often do you update it?

Antivirus software: No Yes Don't Know
If yes, what software and version:
How often do you update it?
What steps have you taken so far to protect yourself online?
What steps have you taken to protect yourself offline?
How long have you been using the Internet?

What level of internet user are you?

Consumer - You can check your email, surf the web and chat, but that's about it. You might have a web site, but you don't really know HTML. If you don't understand anything else we're asking about, pick this one.
Power User - You can also install and configure different programs so that they work with your internet access. You know HTML. You know how to get the full headers of messages in your email program(s).
Expert - You can accurately trace email and usenet messages to their origin, get registration information for domains and find out who owns IP addresses.
Guru - You are a sysadmin, or you train other to be advanced users. You know all about firewalls, proxies, anonymizers, daemons, etc.
Please indicate where you live - there may be a law on the books to help you.

Country:
Province, State or Territory:
Providing the following information is completely optional, but will help us greatly when compiling statistics for law enforcement. This information does not in any way affect how your case is handled. If you don't want to provide the information, simply choose "not saying":

Gender:
Female
Male
Not saying

Age (if you're an adult helping a kid or teen who is a victim, please list their age):
Under 10
10-15
15-18
Not saying

Race/Nationality:
African-American
Asian
Caucasian
Hispanic
Native American
Other
Not Saying

WHOA-KTD does not practice or support any type of discrimination.

Please be patient - we work with many victims and will get back to you as soon as we can. We are all volunteers and we are not online 24 hours a day, 7 days a week. We need time to assess your questionnaire and what to do next - you will not get results overnight. We understand you want something done right now, but please understand that we cannot realistically make that kind of commitment. We'll do everything we can to help you, but you must be patient. Do NOT submit the questionnaire multiple times - it will not speed up the response.

By submitting this form, you certify that all of the information you have provided is true to the best of your knowledge, and that you will be completely truthful in your interactions with any and all WHOA-KTD personnel.