Referral Waiver Request Referral Waiver Request Form By filling out this form you are requesting that your supervisee receive a waiver from the Texas Department of Criminal Justice’s Community Justice Assistance Division (CJAD) to pause their Batterers Intervention & Prevention Program (BIPP) services during the COVID-19 pandemic. Tarrant County Judge Glen Whitley signed a declaration of local disaster, which has temporarily shuttered in-person services. This form confirms that your supervisee was actively attending groups at SafeHaven of Tarrant County’s Partner Abuse Intervention & Prevention (PAIP) program when the shelter-in-place order was made. While SafeHaven’s PAIP program is offering virtual groups for clients during the pandemic, your supervisee does not have a phone or the Wi-Fi technology to participate in group during this time. By filling out this form, you are requesting that your client receive a waiver to pause their program enrollment during the pandemic, and allow them to continue group when the agency is able to bring clients back to in-person groups. Department Name * Today's Date * MM DD YYYY Superviser Name * First Name Last Name Supervisor Email * Supervisee Name * Client who needs to pause program enrollment. First Name Last Name Thank you!
