Nonprofit Restorative Justice Program Referral

Nonprofit Restorative Justice Program Referral — Form Fields

This nonprofit template includes 9 fields. Refer a young person or adult to a restorative justice program for diversion from the justice system. Free to customize and use on ZenBuild.

• Referred Person's Name (first name only) (text, required)
• Referral Source (dropdown selection, required) — options: Court, School, Probation Officer, Family Member, Self-Referral, Community Partner
• Referrer Name and Title (text, required)
• Referrer Email (email, required)
• Age Group (dropdown selection, required) — options: Under 12, 12-17, 18-24, 25-34, 35+
• Nature of Incident or Charge (text, required)
• Is participation voluntary? (dropdown selection, required) — options: Yes, No, Unknown
• Background and context relevant to case (long text, required)
• Preferred contact for follow-up (text, optional)