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Common Referral Form

The LCN Referral Form covers all of our programs, except WDVCAS, EAPA, SHLV and STSH. Once submitted, one of our team members will contact you.

Once you complete the form, an assessment will be conducted to see whether the client fits our criteria. If a Specialised Housing Service response is appropriate, we will seek to gain a coordinated and collaborative response with you. 

Linking Communities is not an NDIS provider and we cannot accommodate unaccompanied children under 16 years.

Privacy Statement

Linking Communities Network Ltd collects your personal information in order to provide assistance, support and advocacy to clients. This information will provide important statistics and help us find the most suitable service to suit your needs. Your personal information is protected under law and will not be passed on to anyone without your consent

Question for client
Do you provide consent for your personal information (name, sex, date of birth and suburb), the date you applied for assistance and the name of this service; to be available to other government and non-government homelessness services in NSW for one year after today’s date? Your personal information will be managed in accordance with the Information Privacy Act 2009.

Program

When is the Support Needed?

Type of Referral

Priority

Gender

Is the Client Culturally and/or Linguistically Diverse?

Is an Interpreter Required?

Is the Client Aboriginal or Torres Strait Islander?

Type of Assistance Required

Is the Client/s Homeless?

Is the Client/s at Risk of Homelessness?

Are You Aware of Any Domestic and Family Violence Issues?

Are There Any Safety Concerns for the Client?

Are You Aware of Any Centrelink/Financial Issues?

Is the Client/s Receiving Mental Health or Alcohol and Other Drugs Services?

Is the Client Engaged with the NDIS?

Are there any Legal Issues or Court Orders Pending?

Are There any Safety and Risk Issues (WHS) for Workers?

Existing Client of a Service Agency?

This confirms that the client/applicant has been read the above privacy statement, indicated that they understand what it means and have given their verbal consent to the above **Consent is valid for one year from date of signing unless otherwise stated