School Help Request - Menslink
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School Help Request
"
*
" indicat
es
required fields
Step
1
of
4
25%
Name of School
*
Amaroo School
Calwell High
Gold Creek School
Kaleen High
Lanyon High
Lyneham High
Melba High
Namadgi School
Queanbeyan High
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 servic
es,
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 fo
und
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 servic
es
are available for young guys between 10 and 25.
If you fall outside of these age rang
es,
you can find out some more info here.
DD slash MM slash YYYY
Year Level
*
Is the Student Aboriginal, Torr
es
Strait Islan
der
or CALD?
*
Y
es
No
CALD
Unsure
Parent/Carers Name
What is the Suburb of the Student's Primary Residence?
Is the Student Aware of this Referral?
*
Yes
No
Are there any other Agencies Involved?
Yes
No
Unsure
If Yes – please provide details of the Agencies if known.
*
Reason for the Referral
*
Email
This field is for validation purposes and should be left unchanged.
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