Forensic Interview

FI referral submissions are only accepted from Law Enforcement, Tribal Social Services, and Michigan Department of Health and Human Services. If you are from one of these agencies, please fill out the form below in as much detail as possible to schedule a Forensic Interview with Mashkawizii CAC. The Forensic Interviewer will contact you with instructions within 48 hours of receiving the referral. For additional assistance, please email our interviewer at ehdavid@baymills.org.

If you are NOT from one of these agencies, please refer to the "Report Abuse" page.

Forensic Interview

Please submit a separate referral for each child involved in a case to be interviewed.

Referral Agency (include county)

Referral Name

Referral Email

Direct Phone Number for Referral Source

Names of Additional Agencies Involved (CPS, LE, etc.)

Names of Agency Workers Involved- Please include email addresses for scheduling purposes.

Is this an urgent or emergency interview? Have the allegations occurred within the last 72 hours? Does the perpetrator have access to the child?

Yes

Child's Name

Child's Date of Birth

Month

Day

Year

Child's Ethnicity

Does the family have any Native American Heritage? Please advise which tribe the family may be a member of.

Did the allegation occur on a tribal land or other federally governed land (military, etc.)

Yes

Unsure

Child's Gender

County Child Resides in

County Alleged Incident Occurred

Date Alleged Incident Occurred

Are there any special needs or accommodations necessary for the child or family? (Autism, Speech/Language Impairment, Sensory Disorders, ODD, ADHD, etc.)

Alleged Perpetrator's Name

Alleged Perpetrator's Date of Birth

Alleged Perpetrator's Relationship to Child

Is the non-offending caregiver aware of the allegations?

Yes

Non-Offending Caregiver's Name

Non-Offending Caregiver's Phone Number

Non-Offending Caregiver's Relationship to Child

Please List Dates and Times ALL Involved Parties are Available. Note: Interview slots M-R are as follows 10am, 12pm, 2pm. Investigative Team should arrive 15 minutes prior.

Who will contact the family for scheduling?

Referral Source

Additional Agency named above

Summary of Allegations:

Please attach any additional reports or documents relevant to the complaint. DO NOT INCLUDE CSAM PHOTO EVIDENCE.

Mashkawizii Child Advocacy Center

Forensic Interview

Mashkawizii Child Advocacy Center