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Military Service Affiliation - Support Workers Enquiry

If you are a support worker completing this on behalf of an ADF member or veteran, please complete the following section. This helps us confirm eligibility and better understand their background.


We offer tailored support through accommodation, recreation, and advocacy services. Your responses help us prioritise bookings and ensure you receive the most appropriate assistance.

Who are you completing this form on behalf of?
Current serving ADF member
Veteran ( former serving ADF member)
Partner / Spouse
Child of the ADF member or veteran
Parent of ADF member or veteran
Other family member

Please provide the full name of the person you are completing the form on behalf of.

Please provide the full name of the ADF member or veteran that the above-named relative is related to.

Which branch did the ADF member serve in?
Army
Navy
Air Force
Other - International Forces
Not applicable

Section 1 - Information about DVA and the ADF Member or Veteran

Does the member hold a Department of Veterans Affairs (DVA) card?

Information about DVA cards help us to understand your eligibility for certain supports and services. If you're unsure, just select "Unsure".
Yes - Gold Card
Ye - White Card
Yes - Orange Card (for overseas veterans)
No, does not have a DVA card
Unsure
Does the ADF member or veteran, hold an RSL membership
Yes - Current Member
Yes - Life Member
No - Not a Member
Unsure

Accommodation Needs - Your responses will assist us understand the situation and prioritise support. All information will remain confidential.

What type of support are you seeking from us?
What is the reason for the Emergency Accommodation request?
Room Allocation Needs Assessment
Single Person Room
Couple Room
Family Room
RV / Caravan Site - Powered
RV / Caravan Site - Unpowered

Accessibility Needs Assessment - Does this person have any accessibility needs we should be aware of?

Medical Health and Wellbeing Information

This information is used solely to ensure safety and comfort of guests during their stay or engagement with us. It will not be shared outside our team without your consent.

Do you (or the person you're completing this form for), have any medical, mental health, or drug and alcohol related conditions that we should be aware of to support safety and wellbeing?

Medical Health Information

NDIS Information

Is this person an NDIS participant?
Yes - Self managed
Yes - Plan managed
Yes - NDIA managed
No - Not an NDIS participant
Unsure
Do you have NDIS funding for short-term accommodation (STA) or respite?
Yes
No
Unsure

Financial Questions

This question is entirely optional and your response won't affect your dignity or how you're treated - we're simply here to help where we can.

How would you describe your current financial situation?
What is your current employment status?
Employed Full-time
Employed Part-time or Casual
Self-employed
Seeking work / Unemployed
Retired
Student or in training
Unable to work due to injury or illness
Carer or stay-at-home parent
Supported through DVA, NDIS or pension
Prefer not to say

Thank you for taking the time to complete this form. We appreciate you sharing your information. We will review your information as soon as possible. While we do our best to support everyone who reaches out, there may be circumstances where we're unalbe to provide direct assistance.


If that's the case, we'll do our best to refer you to an appropriate service or provide guidance on the next steps.


We truly appreciate you reaching out - and no matter the outcome, you're not alone.


If your need is urgent or you're unsure where to turn, please contact us on 0420 102 090. Alternatively, you can contact:

Lifeline on 13 11 14 or

Open Arms on 1800 011 046.

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