Refer - South Yorkshire Sexual Violence Partnership

Referral Details

If the child is under 18 and not living independently, please provide contact information for a person who has parental responsibility or a safe and appropriate adult whom we can speak to on behalf of the child?

Contact phone(Required)

Relationship to child(Required)

Organisation(Required)

Referrer email(Required)

Referrer phone(Required)

If ‘no’, what is the reason for this?(Required)

Personal Details

Date of birth(Required)

Phone(Required)

Email(Required)

If yes to the above, please state which language(Required)

Information about the child (for clients under the age of 18)

If yes, please provide the name and contact details if known.

If yes, please give details (including under what category) ?(Required)

Are there any other risks in relation to the child that we need to be made aware of that are not recorded elsewhere on this referral form?

Risk Information

Please give further details about risks identified.(Required)

If yes, please give details of the support services the client has been referred to.(Required)

Incident Details

Please tell us the reason for referral (offence, date(s), relationship to suspect) We know this can be very difficult so please only share what you feel comfortable with. (Max 800 characters)(Required)

If ‘yes’, do you have the details of the Officer In Charge (OIC) or the Crime reference number?(Required)

If yes, please give additional information (date and reason for court appearance).(Required)

Monitoring Information

To complete the referral process, we need to collect some basic monitoring information. This helps us improve our services and is a requirement of our funders. The details provided will be reported anonymously.

Ethnic group or background(Required)

Gender(Required)

Sexuality(Required)

Do you have any special needs that we need to be aware of? This may include communicative needs or ground floor access.(Required)