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 Elisha Call at ecall@mikids.org or call (989) 627-4344 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 and Investigator Name (if different from referral source):

Law Enforcement Investigator Phone Number and Email (if different from referral source)

Law Enforcement Case Number

CPS Agency and Investigator Name (if different from referral source):

CPS Investigator Phone Number and Email (if different from referral source)

Please list available dates and times of all investigators. Responding LE and CPS must coordinate availability prior to scheduling FI.

Child(ren)'s Full Name

Child(ren)'s Date of Birth

Any special considerations/needs for the child?

Non-offending Caregiver's Name

Non-Offending Caregiver's Relation to Child

Non-Offending Caregiver's Phone Number *

Alleged Perpetrator Name

Alleged Perpetrator's Date of Birth

Alleged Perpetrator's Relationship to Child

Alleged Perpetrators last known contact with the child(ren)?

Does the alleged perpetrator have immediate access to child?

If yes, please explain.

Is the Non-offending Caregiver aware of the allegations?

If no, please explain.

Is the caregiver aware we will be in contact with them?

Summary of Allegations (Include additional children to be interviewed)