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 Wednesday 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
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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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Aboriginal
Torres Strait Islander
Neither
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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Addiction or recovery-related support needs
Assistance required following unexpected financial stress
Disabilities impacting daily living or income stability
Domestic or family violence
Experiencing homelessness or risk of homelessness
Experiencing isolation or limited support networks
Family breakdown or relationship separation
Financial hardship
Food insecurity or difficulty meeting day-to-day living costs
Increased expenses related to caring responsibilities
Limited or no access to basic household items
Mental illness or mental health challenges
Need for essential items due to moving into new or emergency accommodation
Recently arrived and lacking essential items
Support needed due to natural disaster or crisis event
Support needed while awaiting government payments
Support required due to sudden illness or hospitalisation
Support required for children’s essential needs
Unemployment or reduced income
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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