About Us
Attorneys
In the News
Catholic Church
Archdiocese of Newark
Diocese of Metuchen
Diocese of Paterson
Diocese of Camden
Diocese of Trenton
Boy Scouts
Other Institutions
Contact
About Us
Attorneys
In the News
Catholic Church
Archdiocese of Newark
Diocese of Metuchen
Diocese of Paterson
Diocese of Camden
Diocese of Trenton
Boy Scouts
Other Institutions
Contact
Step
1
of
9
11%
Thank you for taking the time to provide the information requested in this online questionnaire. We will use this information in our negotiations with the Diocese and to aid our investigation regarding your claim.
Please do not guess or feel compelled to provide answers to questions if you do not know the answer. For example, if for some reason you cannot recall exact dates, please give us your best estimate and let us know that you do not recall specific dates. And please do not be alarmed if you cannot recall the dates as we will likely have other ways to obtain the dates. We understand that you will likely recall more information as time goes on, so please only provide the best information that you can today. You are always welcome to share more information with us, and we will likely have the opportunity to provide more information down the road.
We are providing this form because some people find it easier to provide the information in this fashion. Please let us know if you would rather provide this information over the phone.
Please know that the information you provide to us will be kept confidential and will not be shared with anyone else other than the Diocese.
Name
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Date of Birth
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Current Marital Status
Married
Single - Never Married
Single - Divorced
Single - Spouse Deceased
Years Married
Do you have any children, including: biological, adopted, or step-children?
Yes
No
How many children?
What is your highest level of education?
Left High School Before Graduation
High School Graduation
GED
2-Year College
4-Year College
Post-Graduate Degree
Other
If Post-Graduate or Other, please specify:
Are you employed?
Yes
No
Current Employer
Employer Name
Employer Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Please provide a brief description of your work history, including your current position:
In which state did the abuse primarily occur?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Did the abuse occur in any other states?
Yes
No
Which other states?
In which Diocese did the abuse primarily occur?
Archdiocese of Newark
Diocese of Metuchen
Diocese of Paterson
Diocese of Trenton
Diocese of Camden
As you likely know, some priests and other religious were transferred between Dioceses, including transfers as a result of child abuse. We will work to find this information, but please let us know if you believe your abuse may have involved more than one Diocese, such as a person who was transferred from another Diocese before they abused you. Did the abuse involve more than one Diocese?
Yes
No
What other Diocese(s)?
Archdiocese of Newark
Diocese of Metuchen
Diocese of Paterson
Diocese of Trenton
Diocese of Camden
Do you know the name of your abuser?
Yes
No
What is the name of your abuser(s)?
If you do not know the name of your abuser(s), please provide a physical description of the individual(s)
What was the role of the abuser(s)?
Priest
Religious Order Member
Lay Person
Other
What was the other role?
Did the abuse occur at a parish?
Yes
No
Which Parish?
Did the abuse occur at a school?
Yes
No
Which school?
Do you believe you know the approximate date, month, or year that you believe he or she first abused you? We know this may be difficult to remember, so please do not guess. If you cannot approximate, please check “I am not sure.”
I believe I can approximate the date of the first inappropriate encounter
I believe I can approximate the month and year of the first inappropriate encounter
I believe I can approximate the year of the first inappropriate encounter
I am not sure
Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
If you are comfortable sharing this information, please select each of the inappropriate things that you recall him or her doing to you. We know this is difficult to provide, but we need this information to help try to resolve your claim.
He or she took naked pictures of me
He or she touched my breasts under clothing
He or she touched my buttocks under clothing
He or she touched my genitals under clothing
He or she asked me to masturbate him or her
He or she performed oral sex on me
He or she had sexual intercourse with me
He or she asked me to remove my clothes
He or she touched my breasts over clothing
He or she touched my buttocks over clothing
He or she touched my genitals over clothing
He or she asked me to masturbate
He or she asked me to touch him or her in a sexual way
He or she had me perform oral sex on him or her
Other
To the best of your ability, describe the nature and extent of the sexual abuse:
Was anyone ever present during any of the conduct that you identify above?
Yes
No
I can't remember
Who was present? (Select all the apply)
My Parent(s)
Another Parishioner
Another Priest
A Nun
Another Student
Another Altar Boy
Another Person that Worked at the Church
A Sibling
Other
If you know, how and why did the abuse come to an end?
How do you think the abuse has affected you and impacted your life? Please check any of the following issues that may apply. In addition, feel free to write a response in your own words by selecting “other.”
Anxiety
Shame
Depression
Sexual Intimacy problems
Trust Issues
Attempted Suicide
Marriage Problems (e.g. Divorce)
Academic (Poor performance in school)
Sleep Problems
Flashbacks
Anger
Guilt
Substance Abuse
Sexual Dysfunction
Suicidal Thoughts
Problems with Anxiety
Hypervigilance
Professionally (Failure to reach full potential)
Nightmares
Other
How else has the abuse affected you and impacted your life?
In cases against the Church we normally have to prove the Church knew or should have known that the person who abused you posed a danger to children. Although the Church may now admit that the person was an abuser, the Church may not be legally responsible for what happened to you unless we can show the Church knew or should have known that you were in danger before or during the time you were abused. We refer to this as “notice evidence” and it is critical evidence for your case – without it we may not be able to prove your case. These questions are designed to help us find such “notice evidence.”
Can you think of any reasons why someone else might have known or suspected that you were being abused? For example, did anyone see you spending too much time alone with the abuser, or did someone see you with the abuser after hours or in a place where children were not normally allowed to go?
Yes
No
Why do you think someone else might have known or suspected that you were being abused?
Can you think of anyone else who may have been abused by the same person?
Yes
No
Who do you think may also have been abused by the same person?
We know that most children do not ever tell anyone about sexual abuse, but when you were a child did you ever tell anyone that you did not like the perpetrator or that (s)he had done something inappropriate to you?
Yes
No
Name of the Person You Told
Approximate Year
What You Told Them
Please do your best to compile a list of all people you remember having possible contact with the perpetrator, even if you don’t think they were abused by the perpetrator.
Name of the Person
Position
Do you believe that anyone else may have ever complained about abuse or inappropriate behavior by the person who abused you?
Yes
No
Please list who and why you believe the person complained.
Name of Person
Why?
Do you have a yearbook from the school or are you able to get one?
Yes
No
Do you recall whether the parish issued a directory or photo directory to parishioners?
Yes
No
Do you have one of the directories?
Yes
No
Do you have any yearbooks or other records from the time period when you were abused that might have the names of other kids who were your same age?
Yes
No
Please immediately call Tim Brothwell at 253-948-0208 and let him know you have these records. We often interview other children because they may have complained about the abuser or they may know of someone else who complained about the abuser.
Please think hard about this question. These types of records can help us identify other witnesses who may have complained about your abuser. It is OK if you do not have these types of records, but please give it some hard thought. If you know of someone who may have these types of records, please call Tim Brothwell at 253-948-0208 and let him know so that we can try to obtain them.
Do you your parents or siblings have yearbooks or other records from the time period when you were abused that might have the names of other kids who were your same age?
Yes
No
I have not asked
Please immediately call Tim Brothwell at 253-948-0208 and let him know you have these records. We often interview other children because they may have complained about the abuser or they may know of someone else who complained about the abuser.
Please think hard about this question. These types of records can help us identify other witnesses who may have complained about your abuser. It is OK if you do not have these types of records, but please give it some hard thought. If you know of someone who may have these types of records, please call Tim Brothwell at 253-948-0208 and let him know so that we can try to obtain them.
Please consider asking, even if you do not disclose why you are asking. These types of records can help us identify other witnesses who may have complained about your abuser. If you talk to someone who does have these types of records, please call Tim Brothwell at 253-948-0208 and let him know so that we can try to obtain them.
Have you ever sought counseling which you now believe was directly or indirectly related to the abuse?
Yes
No
Please explain why you believe the counseling was related to the abuse:
Approximately what year did you first receive counseling?
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Approximately how long did you participate in counseling?
Over the course of your life have you had any out-of-pocket expenses for the abuse? For example, have you paid for counseling or medication?
Yes
No
What was the out of pocket expense and what is your best estimate of the cost?
Have you ever filed for bankruptcy?
Yes
No
Are either of your parents alive?
Yes
No
Would you be comfortable with us talking with your parents about the abuse if we first talked with you before reaching out to them?
Yes
No
The Child Sexual Abuse Act becomes effective on December 1, 2019, and provides a two year “window” for you to file a lawsuit between December 1, 2019, and December 1, 2021. We are preparing to file lawsuits on December 1, 2019, for our clients who want to move forward with litigation. Please let us know if you would like to be included in a lawsuit that is filed on December 1, 2019. If you say “yes,” please know that we will follow up with you to discuss a specific strategy for your claim, including whether you should consider joining your claim with the claims of other people. If you say “maybe,” please know that we will follow up with you to discuss your questions or concerns so you can decide what you would like to do. If you say “no,” please know that we will continue to work on trying to resolve your claim, and we will work with you to ensure your rights are protected before the “window” closes on December 1, 2021.
Do you want to file your claim against the Diocese on December 1, 2019?
Yes
No
Maybe
Thank you very much for taking the time to complete this questionnaire. We know that it can be very painful to re-live your experiences by describing them in writing and appreciate you taking the time to do so. This will help us immensely in pursuing your case on your behalf. Is there anything else that you would like us to know about your answers or about any other issue?
Thank you again for taking the time to provide this information. If you have any questions or concerns, or want to share additional information, please do not hesitate to contact Tim Brothwell at 253-948-0208.