School Help Request

Name

This field is for validation purposes and should be left unchanged.

Name of School*

Data Collection and Privacy Policy*

By continuing using this form and providing your details you give consent to Menslink to use this information to provide their services, including the off-shore storage of your information. Please note that if Menslink is served with a Subpoena by a Court of Law to provide information, Menslink must do so. Likewise, as a Mandatory Reporter, Menslink is required by law to immediately report child physical and sexual abuse to CYPS. More information can be found in Menslink’s Privacy Policy.

I agree

Name of Referrer*

First Last

Position*

Best Contact Number?*

Email Address?*

Name of Student*

First Last

Date of Birth

Menslink’s services are available for young guys between 10 and 25. If you fall outside of these age ranges, you can find out some more info here.

Year Level*

Is the Student Aboriginal, Torres Strait Islander or CALD?*

Parent/Carer's Name

What is the Suburb of the Student's Primary Residence?

Student's Primary Residence address

City Post code

Is the Student Aware of this Referral?*

Are there any other Agencies Involved?

If Yes – please provide details of the Agencies if known.*

Reason for the Referral*