MDT FORENSIC INTERVIEW REQUEST

Forensic Interview requests are accepted from Law Enforcement and Department of Health and Human Services in Michigan and Wisconsin. If you are from one of these agencies, please complete the form below to schedule an interview with the Caring House Child Advocacy Center. You will be contacted within 24 hours of receiving the referral. If you are not from an agency, please call Law Enforcement, DHHS or the CAC for assistance.

Agency

Your name

Referral source phone number

Provide some date & time options for requested Interview

Other agencies involved?

Yes

If yes, please include: agencies involved, contact names, & phone numbers

Child's first name

Child's last name

Date of birth

Other children in the home?

Yes

If yes, please include: names & dates of birth

Non-offending caregiver's name

Relationship to child

Phone

Are they aware we wll be calling to schedule an Interview?

Yes

Alleged perpetrator's name

Date of birth

Relationship to child

Date of alleged incident

Location of alleged incident

Summary of allegations (in child's words) & any other necessary information...

If you have a report or other supporting documents, please attach below so we can review:

Upload Report

Thanks for submitting!