SUNY's Got Your Back Comfort Bags Requests
This is a form to request comfort bags prepared by the State University of New York and its partner organizations for victims and survivors of sexual and interpersonal violence.

Bags are provided to agencies serving innocent victims of crime. Eligible agencies include hospitals and medical providers, rape crisis and domestic violence shelters and programs, and state, municipal and campus law enforcement. Other interested parties may email gotyourback@suny.edu for a determination of eligibility.

Bags are provided to agencies at no cost. The contents of the bag are funded via a Victims of Crime Act grant through the NYS Office of Victim Services. Bags may not be given out as "swag" or other gifts but must only be used for their intended purpose, to assist victims and survivors of crime in New York State.

Pursuant to the terms of the federal grant, agencies providing bags to innocent victims of crime must report back top-level data with no personally identifiable information. Data will be collected through a form provided to agencies by grant staff. Data is provided in a cumulative fashion to help ensure privacy and confidentiality of bag recipients, while meeting the terms of the federal grant.

Agencies will not have to report the characteristics of a single bag recipient, but will answer a series of questions collecting high-level cumulative data about all bag recipients during a time period.

Questions may be addressed to gotyourback@suny.edu.

Email address *
Organization Information
Please answer the following questions about the organization requesting comfort bags.
Organization Name: *
Your answer
Department/Program Name (If Applicable):
Your answer
Organization Contact Information
Please include the contact information for the individual at your organization who will be responsible for communicating with SUNY's Got Your Back Project Staff to receive comfort kits, and provide distribution information monthly.
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Organization Address *
Your answer
Organization Address Line 2 (if applicable)
Your answer
Organization City *
Your answer
Organization Zip *
Your answer
How many bags would your organization like to request? *
Are you a current recipient of VOCA Funds? *
Do you agree to submit cumulative (non-PII) data on a bi-monthly basis to SUNY's Got Your Back Project Staff (per VOCA requirements) on bag distribution/recipients? *
Do you wish to provide us with any additional information?
Your answer
Overview Of Data To Be Collected:
Cumulative/Non-PII Data To Be Collected

• Total SUNY’s Got Your Back Bags distributed

Client Demographic/Bag Recipient Demographic Data (Self-Reported)
• Bag distribution to clients by race/ethnicity (options include):
o American Indian/ Alaska Native
o Asian
o Black/ African American
o Hispanic or Latino
o Native Hawaiian & Other Pacific Islander
o White Non-Latino/ Caucasian
o Some Other Race
o Multiple Races
o Not Reported
o Not Tracked

• Bags distributed to clients by gender identity:
o Male
o Female
o Other
o Not Reported
o Not Tracked

• Bags distributed to clients by age:
o 0-12
o 13-17
o 18-24
o 25-59
o 60 & Older
o Not Reported
o Not Tracked

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