School Help Request - Menslink
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School Help Request
"
*
" indicates required fields
Step
1
of
4
25%
Name of School
*
Amaroo School
Calwell High
Gold Creek School
Kaleen High
Lany
on
High
Lyneham High
Melba High
Namadgi School
Queanbeyan High
Data Collecti
on and
Privacy Policy
*
By continuing using this
for
m
and
providing your details you give consent to Menslink to use this informati
on
to provide their services, including the off-shore storage of your informati
on.
Please note that if Menslink is served with a Subpoena by a Court of Law to provide informati
on,
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 informati
on
can be found in
Menslink’s Privacy Policy
.
I agree
Name of Referrer
*
First
Last
Positi
on
*
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.
DD slash MM slash YYYY
Year Level
*
Is the Student Aboriginal, Torres Strait Islander or CALD?
*
Yes
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.
*
Reas
on for
the Referral
*
Email
This field is
for
validati
on
purposes
and
should be left unchanged.
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