CASA Central Victoria
03 5441 0430
(Mon to Fri, 9am-5pm)
Sexual Assault Crisis Line
1800 806 292
all other times
CASA Central Victoria
03 5441 0430
(Mon to Fri, 9am-5pm)
Sexual Assault Crisis Line
1800 806 292
all other times

Referral forms

One of the most common methods of referrals is from the person who has experienced sexual assault. A person can contact CASACV by calling our Intake and Response Team on 54410430 and request to speak with an intake counsellor / advocate. During this process you will be asked a series of questions, to allow us to understand the assistance needed. This process can take up to 30mins. Alternatively, you can complete the self-referral form below and one of our IRT counsellor / advocates will call you. Please note that CASACV calls from a private phone number.

The forms on this page allow you to easily refer yourself, or a client for our services.

Please contact CASACV on 5441 0430 if you have any queries regarding the completion of these forms.

If you run out of time to complete a form, use the “Save Form and Complete Later” link at the bottom to generate a unique link that you can email to yourself to return and then complete it.

Self referral

LaTrobe University student referral

 

Deciding to be sexual with someone should be an experience that you both want and makes you both feel good. If at any time you don’t feel safe or you’re not enjoying the experience, you have the right stop what is happening. 

To be eligible for this service you need to be a current Student at Latrobe University in Bendigo and have experienced Sexual Assault, either recently or in the past.

Sexual Assault can be defined as any sexual activity that occurs that you have not consented to. YOU HAVE NOT GIVEN CONSENT if you: • submitted to sexual intercourse because of force or the threat of force; were held captive; • were asleep or unconscious; • drunk or under the influence of drugs making you incapable of agreeing or saying no; • didn’t understand the sexual nature of what was happening; • felt too scared to say no; • felt pressured by emotional threats such as “You know you really want this” or “Why else did you come here?”; • were threatened with a relationship break up if you didn’t participate; • were verbally abused as part of the attacker’s manipulation and coercion

Sexual Assault also includes being touched without consent or being threatened verbally with sexual violence.

If any of the above has happened to you, recently or in the past and you would like support – please complete this referral form.

Referral (adult)

Referral (children & adolescents)

Referral (DHHS child protection)

Referral - REFOCUS