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Housing with Drop In Supports
This referral can only be submitted by a Person with disability, Guardian, Support Coordinator, Government Department representative, Homestretch, Salvation Army, Ruah, Mercy Care, Naala Djookan Healing Centre, Stirling Womens Centre etc.
Section A
If referring yourself, complete Section B
Details
Section A only to be completed by Guardian, Support Coordinator, Government Department representative or Case Worker
Your Full Name (not the client)
First Name
Last Name
Your Phone Number (not the client)
Your E-mail (not the client)
example@example.com
Organisation
Section B.
About Person requiring housing
Name
*
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
NDIS Number (if known)
Preferred Suburb
Does the person have a history of any of the following:
*
Substance abuse alcohol or other drugs
Property Damage
Unpredictable violence and aggression
None of the above
So that we can assess the urgency of the accommodation requirement please tell us about your the current situation:
*
Upload NDIS Plan (if available)
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