McAuley Works Referral Form - McAuley Community Services for Women

Referral

if you wish to participate in this program, please click here to provide your information.

Organisation name*

Contact person*

Phone*

Email*

Please specify service type: (e.g., youth justice, housing, family violence):

Date of birth*

Country of birth*

Preferred language:*

Contact number*

Email*

Please indicate reason for referral*

Ages of children

(Please provide written, digitally signed, or email/text trails that outline clients given consent as verbal consent on its own is not satisfactory)

Participant signature:*

Date*

Please attach any MARAM documentation to referral email.

Accepted file types: pdf, doc, docx, Max. file size: 12 MB.

Please specify details of current risk, any recent incidents, IVO, safety plan etc.*

Overview of current housing (temporary accommodation, stable housing, private rental, refuge etc.)*

What is the visa status? (temporary visa, student/partner visa, permanent resident, working rights etc.)*

Please specify visa category:*

Please attach a copy of the visa to referral email.

Accepted file types: pdf, doc, docx, Max. file size: 12 MB.

If so, please specify the Provider

Overview of case management provided by your organisation/program and expected support period:*

Please specify course and study hours

Please specify average hours per week, place of work and role

What are their employment goals? Please specify if they have any training needs, previous employment experience, current qualifications.

What are the barriers to employment? (e.g. mental health, disability, language skills, lack of childcare etc.)

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