Aboriginal Family Wellbeing and Violence Prevention

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Aboriginal Family Wellbeing and Violence Prevention

This service can offer the following assistance:

Individual and family support for people suffering or at risk of suffering the effects of family violence
Assistance to access other services
Advocate on your behalf with services
Support and encourage victims or those at risk to use the specialised support services available

If you think that family violence is occurring in your family, or there is a risk of it happening and would like further information and support, please contact Jimmy on 6883 2300 or 0407 636 594.

FAMILY VIOLENCE IS NOT PART OF OUR CULTURE - let's keep it out!

Online Referral Form

Organisations or individuals to use this form to refer themselves or another person with consent to the Connecting Community Services program as selected below.

* Mandatory fields

Connecting Community Service’s programs *

Client Details (Person being referred)

First Name *

Last Name *

Date of Birth *

Age (at time of referral)

Gender *

Address

City

State

Postcode

Phone

Email *

Is it safe to contact the client as below? *

(tick box/s for all relevant)

Phone

Allow to leave voice message Allow to send SMS

Email Postal Mail

Do you identify as being Aboriginal or Torres Strait Islander? Aboriginal Torres Strait Islander

Country of Birth

Main language spoken at home

Other language

Is an Interpreter required?

Residential Status

Visa Type

Year/Month of Arrival in Australia

Next of Kin

Full Name

Parent/Carer if client is a child.

Relationship

Phone

Details of Other Family Members Requiring Support

1) Full Name

DOB

Gender

2) Full Name

DOB

Gender

3) Full Name

DOB

Gender

4) Full Name

DOB

Gender

5) Full Name

DOB

Gender

Referrer Details (if applicable)

Full Name

Position or Relationship to client

Organisation (if applicable)

Address

Phone

Description of Presenting concerns / What prompted the referral? *

What other services are currently involved?

Fines

Worker to discuss with client Work and Development Order (WDO) (eligibility conditions apply)

(Court fines, Victims Restitution Orders, Penalty/infringement notices / on-the-spot fines)

Additional Information

Consent *

Please tick each box to submit the referral.

Client (including parent/carer if a child) understands and agrees to their information being shared with Dubbo Neighbourhood Centre Ltd - Connecting Community Services for the purpose of determining eligibility to the program.

Client (including parent/carer if a child) understands that they will be contacted by the allocated worker to arrange an assessment/intake.

The referrer agrees they has gained the client’s consent for the referral, and that all information submitted in this referral is an accurate reflection of the client’s support needs and client information.

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