Staying Home Leaving Violence Referral Form
This form is for service providers to refer those who need support with domestic and family violence but wish to remain in their home and have the perpetrator leave.
Once you complete the form, an assessment will be conducted to see whether the client fits our criteria.
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.