SVLO Referral Form

This form allows you to request confidential support from a Sexual Violence Liaison Officer (SVLO). SVLOs provide a safe, non-judgemental space to talk about experiences of sexual misconduct and harassment, whether this happened recently or in the past.

You do not need to know what support you want, and there is no pressure to take any formal action. An SVLO can listen, explain your options, support you with reporting (if you choose to), and help you access specialist or academic support at your own pace.

Submitting this form does not start a formal process. It is simply a way to ask for support. Appointments can take place in person, online, or by phone, depending on what feels most comfortable for you.

If you are in immediate danger, please contact emergency services on 999.

About you

Your full name

Your student ID number

Your date of birth

Your contact email

Reason for referral

Please tell us briefly what you would like support with from the SVLO service.
(You can share as much or as little detail as you feel comfortable with.)

When did the incident(s) or concern(s) occur? Within the last 7 days Within the last 3 months More than 3 months ago Prefer not to say

What you'd like from us

How would you like the SVLO service to support you?
(Examples: safe space to speak with someone, understanding your options, reporting options, academic adjustments, referrals.)

Have you already spoken to anyone about this? No Yes – University staff / Union of Student staff / Police / GP / Friend or family / Another service

Is there anything specific you would like your SVLO to know before meeting with you?

Consent & data handling

Consent to contact I consent to the SVLO service contacting me about my referral

Consent to store information I consent to my information being stored securely in line with the Union of Student’s privacy policy