Restorative Justice Unit Referral Form - I am referring on behalf of another

Your role
Are you acting as a representative of the person harmed (victim) or the person who caused harm?*

person harmed (victim)person who caused harm

Your details
Your name*

First NameLast Name
Role*
Agency name*
Contact number*

Area CodePhone Number
Email*
Enter a valid agency email address.
Note that the party you are referring on behalf of must be aware of this referral, as restorative justice is a voluntary process.
Have you spoken to the person you are acting for or representing about this referral?*

NoYes
Are they willing to engage with a restorative justice process?*

NoYes
Do they consent to being contacted to discuss this referral?*

NoYes
Please provide further information about their willingness to engage, views expressed, and any important dates to note:*

Referral Information
Does the person you are referring need help to communicate with us? This could include using an interpreter, assistive technology, or receiving information in an alternative format.*

NoYes
Select all that apply

Large print or another accessible digital format for documentAuslan interpreterEasy-read or plain English informationTranslated materials or a translator required (please let us know what their first language is)Communication partner or assistantSensory sensitivitiesOther
Please specify their first language*