Intake

482 Collective | Pre-Intake

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Referral Process

PLEASE NOTE: WE ARE NOT AN EMERGENCY SERVICE

We support women, children and individuals from marginalized communities who are struggling with poverty after fleeing human trafficking and other gender based violence including: intimate partner/domestic violence, sexual assault, and physical/emotional abuse.

We do not accept self-referrals
All referrals must come through a case manager/crisis worker/police or community organization
Client will be contacted within 6-9 business days after pre-intake form is received

CATCHMENT AREA
We currently deliver to: Toronto (East York, Etobicoke, North York, Scarborough, Toronto, York) York Region (Aurora, East Gwillimbury, Georgina, King, Markham, Newmarket, Richmond Hill, Toronto, Vaughan, Whitchurch-Stouffville) Peel Region (Brampton, Caledon, Mississauga)

Pre-Intake Form
Must be filled out by Case Manager/Crisis Worker/Police Officer

Referred by

* Indicates required field

Name *

First

Last

Email *

Name of referring organization *

Eligibility Criteria

Client MUST meet all 3 parameters: *

Has fled human trafficking or gender based violence IN CANADA within the past year Is a Permanent Resident / Citizen of Canada Is currently struggling with poverty

Year client fled abuse *

Month client fled abuse *

Please only refer clients who qualify for our services
Please note: we only deliver within our catchment area

Client Info

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone number *

Date of Birth

Month *

Day *

Year *

Is your client pregnant? *

How many children does client have? *

Does your client have access to their children? *

Client is a survivor of: *

Income Bracket *

Does client require an interpreter? If yes, referring organization must provide one *

Safety Info

Is client currently living with the perpetrator/abuser? *

Does client have a Protection Order in place? *

Does the abuser have knowledge of client's current address? *

Is the abuser stalking, harassing, or showing up randomly? *

Please provide a brief summary of your client's SITUATION *

Client will be contacted within 6-9 business days. If after 3 attempts we cannot reach your client, would you like to be updated by email? *

Submit

Thank you for your referral

What your client can expect after you submit a pre-intake form on their behalf:

We will contact your client by phone or email within 6-9 business days to set up an intake
The intake process will take approximately 15-25 minutes
If after 3 attempts, we cannot reach your client, we will notify you by email if you have selected this option on the pre-intake form
If we are unable to support the client, we will make every effort to provide them with additional referral resources

Download our current referral process for your files:

482_referral_process_sep2023.pdf
File Size:	153 kb
File Type:	pdf

Download File

image: umitbus

482 Collective | Pre-Intake​