Non-profit victim service agencies, advocates, and partnerships that provide services to survivors of domestic violence, dating violence, sexual assault and stalking may adapt these forms, policies and agreements for immediate use.  Use Step-by-step easy instructions!

Model Template Intake Form

For many programs, the intake process is part of the beginning steps of establishing a trusting relationship with a survivor and assessing their needs and requests for services. It’s important that this process is nonintrusive and avoids the collection of unnecessary personally identifying information.  This template uses best practices to guide this process in the most helpful way possible for the survivor. 



Download adaptable template form: