South Yorkshire Sexual Violence Partnership
DRASACS
SYPCC
BSARCS
SRASAC
RothACS

South Yorkshire ISVA Service Referral Form

DRASACS will manage the referral to the appropriate local ISVA Service Provider

Client Details

The ISVA will make contact with the referrer/OIC in the first instance to obtain more information before contacting a client. In the case of children & young people, the ISVA may ask for the contact details of a parent/guardian to ensure appropriate consent and establish support networks.

Is the person being referred aware of this referral?

Can we leave a message at these telephone numbers?
Are we authorised to write to the client at this address?

All correspondence is issued in unmarked plain envelopes.
Does the client need an interpreter?
Referrer Details
Incident Details
South Yorkshire Police Referrals ONLY
Has the client given 'explicit consent' as per 'Victims Code'?
Monitoring Information

To complete the referral process, we need to collect some basic monitoring information. This information is a requirement of our funders and is also used for improvement of our services. Collecting the information is important to help us secure funding, so that we can continue to provide a free service for our clients.

The details provided will be reported anonymously.

What is the clients gender?
Data Protection

The data provided on this form is used to identify clients and assist the ISVA worker when contacting agencies as part of their advocacy role. This data on this form is treated as both 'personal' and 'sensitive' and subject to the policies of the local ISVA service provider with respect to confidentiality and data protection.

DRASACS acts as a 'data processor' on behalf of BSARCS, RothACS and SRASACS in order to refer clients into the appropriate local ISVA service provider. BSARCS, RothACS, SRASACS and DRASACS act as 'data controllers' for ISVA clients within their local area.