Client Questionnaire for Boy Scouts Cases

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 Boy Scouts of America, and others who may be responsible for what happened, including the local council and sponsoring organization, 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 Boy Scouts of America and others who may be responsible for what happened, including the local council and sponsoring organization.
Name
Prefix First Middle Last

Save and Continue Later

Date of Birth
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?
Please describe your post-graduate degree(s):
Please describe your highest level of education:
Are You Employed
- Yes
- No
What is the name of your current employer?
What is the title of your current position?
Please provide a brief description of your work history:

Save and Continue Later

Are you a Medicare recipient?
- Yes
- No
Has Medicare paid any bills related to the abuse you suffered, including costs for therapy or counseling?
- Yes
- No
Have you ever filed for bankruptcy?
- Yes
- No
List
Approximately what year did you file for bankruptcy? Where was the bankruptcy filed?

Please include all bankruptcies, if there were more than one.

Save and Continue Later

The following questions are intended to help us further investigate your case. Please do not be concerned if you do not remember some of these details. For example, many people do not remember their Troop number, and many do not know the name of the local council that was responsible for their Troop.
What level of scouting were you participating in at the time of the abuse?
- Boy Scout
- Weblo
- Cub Scout
- Other
What other level of scouting?
What was your Troop/Den/Pack Number?
What was the local council?
What was the sponsoring organization? The sponsoring organization is the organization that sponsored your Troop/Den/Pack, and is usually a church, a school, a YMCA, or a similar organization.

Save and Continue Later

In which state did the abuse primarily occur?
We previously discussed filing a lawsuit on your behalf when the Child Victims Act goes into effect on August 14, 2019. It is our understanding that you want to move forward with filing a lawsuit after that date. Do you still want to file a lawsuit against the Boy Scouts and related after that date?
- Yes
- No
- Maybe
Did the abuse occur in any other states?
- Yes
- No
What states?
Please provide the name of the person(s) who abused you. If you do not remember the person(s) name, please provide any information you can remember, including first name(s), nickname(s), physical description, and/or the approximate age of the person(s) at the time of the abuse (e.g., “caucasian, male, brown hair, mid-40s”):
Name Description
What was the position of the abuser to your Troop/Den/Pack?
Other Adult Role
Other Non-Adult Role
Did the abuse occur at a BSA Camp?
- Yes
- No
Which camp?
What was the name of the camp? Where was the camp located?
Did the abuse occur on a BSA-sponsored camping trip?
- Yes
- No
Where was the camping trip?
Did the abuse occur anywhere else?
- Yes
- No
Where else did the abuse occur?

Save and Continue Later

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 pick “I am not sure.”
Date
Month
Year
Year
Please explain how you are approximating the date that you believe he or she first acted inappropriately with you. Again, this is only to help us try to determine relevant dates.
Please provide the approximate number of times you were abused in scouting. We realize this may be difficult to remember, or to know with certainty, so please just answer to the best of your memory.
Do you believe you know the approximate date, month, or year that you believe he or she last did anything inappropriate with you? Again, we know this may be difficult to remember, so please do not guess. If you cannot approximate the last time you believe he or she may have done something inappropriate with you, please pick “I am not sure.”
Date
Month
Year
Year
Please explain how you are approximating the date that you believe he or she last acted inappropriately with you. Again, this is only to help us try to determine relevant dates.

Save and Continue Later

In cases against the Boy Scouts we normally have to prove the Boy Scouts knew or should have known that the person who abused you posed a danger to children. Although the Boy Scouts may now admit that the person was an abuser, the Boy Scouts may not be legally responsible for what happened to you unless we can show the Boy Scouts 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?
Please provide the name of the person(s) who you think 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 inappropriate conduct or that he or she had done something inappropriate to you?
- Yes
- No
Name of person you told Approximate year you told them What you told them
Can you think of any evidence that someone in a position of authority knew or should have known that he or she was acting inappropriately with you or any other children?
Please do your best to provide the name(s) of all people you remember having possible contact with the perpetrator, even if you don’t think they were abused by the perpetrator. Please take your time to think of names because these people often end up being critical witnesses in your case. For example, an adult or another Scout that you remember may be able to provide evidence that someone else complained about the behavior of the person who abused you.
Name of person Position of person

Save and Continue Later

Do you believe that anyone else may have ever complained about abuse or inappropriate behavior by the person who abused you?
- Yes
- No
Name of Person You Believe May Have Complained Why Do You Believe This Person May Have Complained?
Do you have any documentation from your time in the Boy Scouts or are you able to get any?
- Yes
- No
Do you have any photographs from your time in the Boy Scouts or are you able to get any?
- Yes
- No
Please contact us and let us know what you have, and please promptly scan/email us whatever you have. These materials can be very helpful in your case so it is important we obtain them as soon as possible.

Save and Continue Later

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?
Approximately how long did you participate in counseling?

Save and Continue Later

Thank you very much for taking the time to complete this questionnaire. Is there anything else that you would like us to know about your answers or about any other issue?

Save and Continue Later

Step 1 of 12

Call Us: 1-206-462-4334

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

Approximately what year did you file for bankruptcy?	Where was the bankruptcy filed?

Name of person you told	Approximate year you told them	What you told them

Name of Person You Believe May Have Complained	Why Do You Believe This Person May Have Complained?

Name	Description