Request a Forensic Interview

Referrals for forensic interviews are only accepted from Law Enforcement and Child Protective Services. If you are with one of the above listed agencies, please fill out the form to the best of your ability and we will contact you with available times/dates. If you are not from one of the above listed agencies, please email Brittany Wood at Bwood@mikids.org or call 989-859-0447 before making a request. PLEASE INCLUDE ALL INVESTIGATIVE TEAM MEMBERS AND THEIR CONTACT INFO IN REFERRAL. Interviews will be scheduled based on the availability of team members and the family that is listed on this form. Please be as detailed as possible. Thank you and we look forward to working with you!

Referral County

Referral Agency

If OTHER, please list agency and location

Referral Name (Include Title)

Referral Email

Direct phone number for referral source

Law Enforcement Agency, Investigator, and contact info:

CPS Agency, Investigator, and contact info:

Prosecutor/ Legal Representative?

Law Enforcement Case Number

Please list date and times ALL investigators are available (include LE and CPS). Responding LE and CPS MUST coordinate PRIOR to scheduling FI.

Availability of Family:

Child's Full Name

Child's Date of Birth

Child identifies as:

Child's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Any special considerations/needs for the child?

Alleged Perpetrator Name

Alleged Perpetrator's Date of Birth

Alleged Perpetrator's Relationship to Child

Does the alleged perpetrator have immediate access to child?

If yes, please explain.

Non-offending Caregiver's Name

Non-Offending Caregiver's Relation to Child

Non-Offending Caregiver's Phone Number *

Is the caregiver aware of the allegations?

If no, please explain.

Is the caregiver aware we'll be calling to set up the interview?

Summary of Allegations (Include additional children to be interviewed)