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

- 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 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:*

- 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*