CAC Forensic Interview Referral Form

Please use this link when referring families to the Family Services Children’s Advocacy Center. Please fill out a separate referral form for each child being referred. Please input all known information. An advocate will notify you once the family has been contacted. If you have questions or concerns, please contact Kendra Kimmer ( or Sara Seaford ( Thank you for the work you do to protect kids. We truly value your efforts.



"*" indicates required fields

Name of Person Making the Referral*

Child's Name*
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Non-Offending Caregiver's Address*
Is the Listed Non-Offending Parent/Caregiver the Child's Legal Guardian*
Does the Child or Caregiver Require an Interpreter*

Is the Non-Offending Parent/Caregiver Aware of the Allegations*
Is the Non-Offending Parent/Caregiver Aware That We Will be Calling to Schedule the Forensic Interview*
Are the Other Investigators On the Case Aware that You are Referring the Case to the CAC
Has the Child Had a SANE

Suspect's Name*
If the suspect's name and information is not known at this time, please type 'Unknown' in the first box and explain further in the allegation section below
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