LAW ENFORCEMENT REFERRAL FORM

Thank you for your referral.

Please inform the victim that when a staff member reaches out to them from DCFOF, it will appear as a spam call from a '940' number. If this is a crisis situation or the victim needs immediate assistance, please call our 24/7 Crisis Line at 940-382-7273.

Referral Details

Domestic Violence (DV) or Sexual Assault (SA) offense (or both)?

DVSA

Check all that apply (last 30-60 days):

Stalking StrangulationAccess to WeaponsThreat of homicide/suicideWeapons UsedSexual Coercion/AssaultNone

Date of Crime

Referring Officer

Law Enforcement Agency

Referring Officer First Name:

Referring Officer Last Name:

Referring Officer Email:

Referring Officer Phone Number:

Case/Report Number:

Law Enforcement Agency Account Id

Victim Info

Victim First Name:

Victim Last Name:

Victim's DOB:

Check here if victim is a minor

Please share name and contact information of parent or guardian currently participating in the case, if applicable:

Guardian First Name

Guardian Last Name

Guardian Phone

Guardian Email

Guardian relation to Victim

FatherMotherGrandmotherGrandfatherAuntUncleOther

Other relationship

Victim's Preferred Language

EnglishSpanishOther

If you selected 'other', what language?

Victim's Safe Phone Number:

Victim's Safe Email:

Suspect Info

Suspect's First Name:

Suspect's Last Name:

Suspect's DOB:

Suspect's Gender:

WomanManTrans womanTrans manNon-binary

Suspect's Relationship to Victim

AcquaintanceOther Family/Household MemberStrangerUnknownSpouse (Current or Former)Dating Relationship or Intimate Partner (Current or Former)Other

If Relationship to Victim is Other, please explain

Was an arrest made?

YesNo

If no arrest, is there an active warrant?

YesNo

Did the victim receive medical attention? (EMS or hospital)

YesNo

SAFETY CONCERNS:

BRIEF NARRATIVE OF CRIME:

Upload Offense Report:

Upload Family Violence Packet if applicable:

Has a CPS Report been made?

YesNoUnknown

Has an EPO been issued?

YesNoRequestedUnknown

Upload EPO: