Crime Victim Assistance Referral Form

Please note: This page is for Victim Advocates serving law enforcement, counts, and/or nonprofit organizations within the 18th Judicial District of Arapahoe, Douglas, Elbert, and Lincoln counties only.

The IFCS Victim’s Assistance Program has changed. We highly suggest all advocates review the outline below for details. Applications that do not adhere to the guidelines will not be accepted.

  • Victim Advocates may complete this form to apply for financial assistance on behalf of their client.
  • IFCS staff will work directly with victim’s advocates to determine eligibility, financial assistance to be provided, and payment.
  • The Victim’s Assistance Program is operating on a quarterly budget. Applications may be denied if all funds have been expended for the budgeted term. Denied applicants must reapply once funding is available.

Eligibility for Assistance through June 2023:

  • The criminal act occurred within the 18th Judicial District and,
  • The crime has been reported to law enforcement and has a case number and,
  • The incident occurred less than 6 months from the application date and,
  • The applicant can demonstrate that financial need is crime related and,
  • The applicant is requesting vendor-direct payment and,
  • The referral for service was completed by a Colorado Victim Advocate.

Setting Priority Levels:

  • Applicants living in the IFCS financial programs service area of western Arapahoe county covering Centennial, Englewood, Glendale, Greenwood Village, Littleton, Sheridan, and unincorporated areas of western Arapahoe county and,
  • Applicants scoring in crisis or vulnerable in the Safety, Food, Housing and Family/Social Relations domains as set by the modified version of the Arizona Self-Sufficiency Matrix.

Additional Comments:

  • If the form gives you an error, please contact a Resource Navigator by email or phone.
  • Due to the overwhelming number of requests for assistance, we appreciate your patience in waiting for a response from our team.

Referring Party


Incident Information

Non-Discrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or  retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

  1. Mail:
    U.S. Department of Agriculture
    Office of the Assistant Secretary for Civil Rights
    1400 Independence Avenue, SW
    Washington, D.C. 20250-9410; or
  2. Fax:
    (833) 256-1665 or (202) 690-7442; or 
  3. Email:

This institution is an equal opportunity provider.

This statement was updated 8.3.22 in accordance with USDA updates and guidelines.