Transformative Circles Referral Form

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We are offering free transformative circle services as an alternative to repairing harm and solving conflicts that empowers the community, reduce incidences of calling the police, and centers the voice of the victim(s). Our hope is to prove that this process works and is needed in our community. We are asking participants along the process to take small surveys to capture their perspective of the process. We will use clients insight to improve our process and capture the impact it is making. We ask for clients' initials and DOB as a reference point for clients so to keep their identities confidential.

Email *

Name

Gender Identity

Zip Code

Phone Number

Preferred method to be contacted

Text

Phone call

Other:

Preferred time of day to be contacted *

8 am - 11 pm

11 am - 1 pm

1 pm - 4 pm

4 pm - 8 pm

Other:

Required

Are you directly harmed by this conflict or situation? *

Yes

I'm a trained RJ contractor

Other:

If you are not directly harmed by this conflict, please list the names and contact information of the people who are.

How did you hear about us?

In what context did the harm take place?

School

Family

Business

Community

Other:

Clear selection

Please share about the conflict you are seeking services for?

Send me a copy of my responses.

Submit

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