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Menu
Home
Who we are
Our Mission
Our Story
Parent Experience
Our People
Board of Management
Our Team
Organisational Structure
Our Funding
Testimonials
Our Constitution
Annual Reports
What we offer
Our Services
Advocacy
Individual Advocacy
Systemic Advocacy
Legal Symposium
Self-Advocacy
Family Partner (peer work) Program
Training & Consultation
Self-Advocacy
Information & Resources
Finding Your Way Through the Child Protection System
Tip Sheets
FAQ
Brochure
Referral Form
Parent Pack
Useful Links
Our Life, Our Journey
Charter of Rights
Research
Get Involved
Volunteers
Students & Researchers
Membership
Join Our Team
Events
Regular Events / Programs
News and Events
Photos
Contact Us
DONATE
Request For Assistance Form
Home
Who we are
Our Mission
Our Story
Parent Experience
Our People
Board of Management
Our Team
Organisational Structure
Our Funding
Testimonials
Our Constitution
Annual Reports
What we offer
Our Services
Advocacy
Individual Advocacy
Systemic Advocacy
Legal Symposium
Self-Advocacy
Family Partner (peer work) Program
Training & Consultation
Self-Advocacy
Information & Resources
Finding Your Way Through the Child Protection System
Tip Sheets
FAQ
Brochure
Referral Form
Parent Pack
Useful Links
Our Life, Our Journey
Charter of Rights
Research
Get Involved
Volunteers
Students & Researchers
Membership
Join Our Team
Events
Regular Events / Programs
News and Events
Photos
Contact Us
DONATE
Request For Assistance Form
Menu
Home
Who we are
Our Mission
Our Story
Parent Experience
Our People
Board of Management
Our Team
Organisational Structure
Our Funding
Testimonials
Our Constitution
Annual Reports
What we offer
Our Services
Advocacy
Individual Advocacy
Systemic Advocacy
Legal Symposium
Self-Advocacy
Family Partner (peer work) Program
Training & Consultation
Self-Advocacy
Information & Resources
Finding Your Way Through the Child Protection System
Tip Sheets
FAQ
Brochure
Referral Form
Parent Pack
Useful Links
Our Life, Our Journey
Charter of Rights
Research
Get Involved
Volunteers
Students & Researchers
Membership
Join Our Team
Events
Regular Events / Programs
News and Events
Photos
Contact Us
DONATE
Request For Assistance Form
Request For Assistance
FAMILY DETAILS
Name
*
First
Last
Telephone
*
Email
*
Address
*
Street Address
ZIP / Postal Code
Were you a child raised in care?
Yes
No
Do you have a disability?
Yes
No
Do you have other supports or are you involved with any other services?
Yes
No
Cultural background (optional)
Religion (optional)
Gender (optional)
Male
Female
Nonbinary
Please list the names of children, their DOB, and what Care & Protection orders are in place (if any) — please include children’s surname if different from your own) (Orders can be Interim, Supervision, 2 year or 18 years)
REFERRAL SOURCE
Who is making this referral?
Self Referral
Family or Friend
DCP (eg. Case Worker, Child Advocate)
Other Government Dept (eg. Prison, Centrelink, Other)
Health worker (e.g., hospital, GP, Child Health Nurse, Mental Health
Community Services or Agency
Other (specify):
Organisation Name
Name of Referrer
DoC Child Protection office the case is open to
Case Manager’s Name
Do you have a legal representative?
No
Yes
Legal Representative's Name
Team Leader’s Name
Date of Request
Date Format: DD slash MM slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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