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Family Violence Intervention

Family Violence Intervention Program Referral Form

If you have any questions about the Family Violence Intervention Program, please contact April Deitz at (864)-467-3434, ext. 3313 or deitza@compassofcarolina.org.

If you are a referral source seeking help for an individual who may benefit from the Family Violence Intervention Program, please complete the referral form below. You may send the form electronically or you may download the pdf version and mail it to:

Compass of Carolina
Attn: April Deitz
1100 Rutherford Road
Greenville, SC 29609

Family Violence Intervention Referral Form-Electronic Form


Referral Source, please enter the following information regarding the referred person

*REQUIRED

Please enter the following information regarding the victim. FVIP is required to contact the victim to inform her/him of services and the perpetrator's compliance.


Please enter the following information regarding the referring agency