Crisis & Advocacy service referrals
Use this form to recommend community members or clients for EMBARC's Crisis & Advocacy services.
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Is this person a survivor of crime/violence (past or present)? *
This could include, but is not limited to:
  • Domestic or dating abuse (physical, verbal, and/or emotional)
  • Sexual violence (assault, abuse, coercion)
  • Child, elder, or dependent adult abuse or neglect
  • Stalking
  • Bullying or harassment
  • Assault
  • Kidnapping
  • Hate crime
  • Arson
  • Hit-and-run or OWI incident
  • Loss of a loved one to homicide
  • Human trafficking (labor or sex trafficking)
  • Mass violence or terrorism
  • Robbery or burglary
  • Identity theft, fraud, or other financial crime
Does this person speak a Burma language or dialect? *
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