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Short term support referral

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For more information, visit our Short term support service page.

Privacy statement:
Your personal information is collected by Knox City Council to provide Council services, activities, and events. We handle your data in accordance with the Privacy and Data Protection Act 2014 and the Australian Privacy Principles. For more information, see our Privacy Policy.

Who do you want to refer for assistance?

Refer another person

Is the person aware that you are contacting us on their behalf?
Do you have permission to provide their contact details?

We will always provide information on where to find help.

Unless someone’s safety may be at risk, we may not be able to action your request for another person without their consent due to the Privacy and Data Protection Act 2014.

If you do not have consent to share the other person’s contact details, please provide an overview of the presenting issue/s below.

We will call you to discuss the matter and help determine if there is a safety risk.

What is your relationship or connection to the person you are referring?

We may contact you for more information but are unable to provide updates without consent from the individual due to the Privacy and Data Protection Act 2014.

Support needs

What type of assistance is needed? (Check all that apply)

Referee's contact details

Who can we contact about this referral for more information

Contact details

Please provide your preferred contact details so that we can reach you.

Please provide the contact details of the person who needs assistance.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

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