Counseling application

Are you interested in our free counseling and victim services? Do you need help navigating the legal system? Fill out our initial screening form below.

Once we receive your request, we respond within a week from the time your application is submitted.

¿Hablas español?

Vea nuestra aplicación en español aquí >

Application for Services: Initial Screening Form

Tell us about yourself

Or, your family member.

Client first and last name

Adult name, if you are filling this out on behalf of a child. (Optional)

Date of birth

Race/Ethnicity

Gender

Preferred language

Marital status

Years in relationship

Do you or someone in your household have a disability?

Yes No

If yes, please tell us who and what kind of disability they have.

Your contact information

Best phone number

Alternate phone number (optional)

When is the best time to call? Select all that apply.

Morning (8am to 10am) Mid-Morning (10am to 12 Noon) Afternoon (12 Noon to 2pm) Late afternoon (2pm to 5pm)

Address

City

State

Zip Code

Tell us how we can help

What best describes you? Check all that apply.

I'm a victim of crime that happened in Irving. I'm a victim of crime that did not happen in Irving. I live in Irving. I attend school in Irving. I work in Irving.

Are you a previous client of Irving Family Advocacy Center (IFAC)?

Yes No

Who are you requesting services for?

Self Self and other(s) Other(s)

If you selected "Other," please describe what you're experiencing or struggling with.

When life gets messy, hardships can leave us feeling stuck. Irving Family Advocacy Center offers free counseling, victim services, and assistance navigating the legal system, helping people become whole.

Note temporary change of address during repairs:

500 E. John Carpenter Fwy, Suite 250
Irving, TX 75062
Directions from Google >

(972) 721-6521

We're open Monday-Thursday, 8am to 8pm and Friday, 8am to 5pm.

Counseling application

¿Hablas español?

Application for Services: Initial Screening Form

Tell us about yourself

Your contact information

Tell us how we can help

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