Self Referral for Kindness Request
IMPORTANT ANNOUNCEMENT: ProjectKindness will no longer be offering a delivery service. See above for further detail on collection.
IMPORTANT: Please confirm that you have read and understand that this request will be collected by you from our Community Outreach location in Waterloo on Thursday afternoon at 4:30pm:
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Yes
Your Contact Information
What is your first name?
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What is your last name?
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What is your phone number?
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Your Email Address
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What is your residential address?
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Please enter street number and street name.
What is your suburb?
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Please Select
Alexandria
Daceyville
Eastgardens
Eastlakes
Erskineville
Eveleigh
Kensington
Kingsford
Malabar
Maroubra
Mascot
Matraville
Newtown
Pagewood
Randwick
Redfern
South Coogee
Surry Hills
Sydney CBD
Waterloo
Zetland
Other
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Your Details
What is your date of birth?
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/
Day
/
Month
Year
What is your gender?
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Female
Male
Non-binary
Prefer not to say
Other
Are you of Aboriginal and/or Torres Strait Islander descent?
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Yes
No
Unsure
Do you identify as culturally or linguistically diverse?
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Yes
No
Unsure
What is your current family situation?
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Please note any family dependents (including age/s & gender/s) and/or partner here. This helps us personalise the support to best suit your family's needs.
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Your Kindness Request
Do you receive any income/Government support? Please select all that apply
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ABSTUDY
Age Pension
Carer Allowance
Carer Payment
Disability Support Pension
Family Tax Benefit
Job Seeker Payment
Parents Next
Parent Payment
Rent Assistance
Single Income Family Supplement
Youth Allowance
Other
What is the reason for your Kindness Request?
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Asylum Seeker/Refugee
Carer
Culturally and Linguistically Diverse (CALD) Background
Disability
Domestic Violence
Financial Hardship
Recent Break Up
Lack of Support/Isolation
Mental Health
Physical Health
Substance Abuse
Sleeping Rough/Homelessness/Housing Challenges
Young Parent
Youth at Risk
Other
Have you requested kindness from ProjectKindness before?
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Yes
No
Unsure
What kind of items would help you most at this point in time?
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IMPORTANT: Please note that ProjectKindness is unable to provide support with: Larger items (beds, fridges, washing machines, dryers, televisions etc.); Mobile phones or computers; Perishable food items (milk, cheese, bread, meat, fruit and vegetables, etc.); Adult clothing and shoes; Food or clothing vouchers; Medication support; Financial support.
Are you receiving support from any other organisations (e.g. Food Bank, Oz Harvest, Casework Support, etc.)?
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If yes, please let us know who is supporting you and what type of support you are currently receiving. If no, simply write N/A.
How did you hear about ProjectKindness?
Friend
Social Media
Ask Izzy
Google Search
Other
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Proof of Centrelink or Income Support
Please upload an image, scan or screenshot of your latest Centrelink or Income Statement. This statement must have been received within the last 14 days.
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Browse Files
Drag and drop files here
Choose a file
IMPORTANT: Please note that ProjectKindness is unable to respond to requests without correct file upload. Please call us on m. 0431 537 727 to discuss should you require support in obtaining and/or uploading correct document.
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