Emergency Relief EOI Form

Page 1

ELIGIBILITY CRITERIA CHECK

Please answer a few questions to check if you (the Applicant) will be eligible for support from the Emergency Relief program.

Do you reside in any of the areas listed? *

YesNo

List of eligible areas-:

QLD:

North Brisbane

Ipswich

VIC:

South-East Melbourne

NSW:

Parramatta

If you (the Applicant) lives outside of the listed area, please contact a local service provider near you.

Find national and local support- Ask Izzy

This will help you connect with the right organisation in your area.

You (the Applicant) do not meet the eligibility criteria.

To find out about more about Emergency Relief Program visit the government website.

A personal or financial crisis can make it difficult for vulnerable individuals and families to afford the essentials of daily life. The Department of Social Services funds SSI to provide emergency relief services to people experiencing financial distress or hardship and who have limited means or resources.

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CLIENT CONSENT

Welcome!

We, at SSI stand for equality of life – for everyone. Everything we do is driven by equality and empathy, and the belief that every individual has the right to the same opportunities.

Privacy Information Statement

Settlement Services International Limited (SSI) is committed to respecting and protecting the privacy and rights of individuals in relation to their personal information.

SSI Group will collect, keep and deal with your personal information in accordance with the requirements of the Service Navigation Support Service (Service), applicable legislation (including the Privacy Act 1988 and state legislation as may apply) and SSI Group’s Privacy Policy, accessible at https://www.ssi.org.au/privacy/.

SSI’s Privacy Policy sets out how you can access or correct your personal information or make a complaint about a breach of privacy. You may also seek further information or request a copy of the Privacy Policy from SSI Group’s Privacy Officer, at privacy@ssi.org.au. 

Why we need to collect your personal information

The Service collects personal and sensitive information for the purpose of contacting you about the Service, assessing eligibility to access the Service and delivering the Service. We will not disclose your personal information to any other service provider without first seeking consent from you.

The types of personal information we will collect about you may include:

your name and contact details  
your cultural and language background, and
your health information.

We will use this information to:

contact you about your Expression of Interest
assess eligibility for the Service
provide services to you
assess and improve our service delivery, and  
evaluate program outcomes and to report on these to funding bodies.

When we might give your information to other

For the above purposes, your information may be given to the funder of the Services,Department of Home Affairs, if requested.

What if you don’t want to give us the requested information, or if you change your mind

We need to collect this personal and sensitive information for the purpose of contacting you about the Service, assessing eligibility to access the Service and delivering the Service. You do not have to provide consent and your decision not to provide consent will in no way affect the Services we provide to you. However, if you do not provide sufficient information in the Expression of Interest, it may mean we are unable to assess eligibility for the Service.

You are free to change or withdraw your consent at any time by following the procedure in the Privacy Policy. Talk to your contact at SSI, who will support you to change or withdraw your consent.

I have read the above information. I understand the reasons for SSI to collect my personal information and the ways in which it may be used and disclosed, and I provide my consent to that collection, use and disclosure. I understand I am free to withdraw consent at any time. *

YesNo

If you select "No" you will not be allowed to submit this form

I understand completion of this Expression of Interest does not guarantee acceptance into the Service. Acceptance will be determined based on meeting eligibility requirements and availability of services. *

YesNo

If you select "No" you will not be allowed to submit this form

Thank you for your interest. Unfortunately, we are unable to proceed with your expression of interest as we did not receive consent. Please feel free to reach out if you have any questions or need further information.

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REFERRER DETAILS

Who completed the form? *

Referring Organisation *

Your Name *

What is your Role at this Organisation *

Your Contact Number *

Your Email *

PRIMARY APPLICANT'S DETAIL

Given Name *

Family name *

Gender *

Date of birth *

Email Address

Phone number *

Date of arrival in Australia *

Country of Birth *

Visa Type *

Main Source Of Income *

Main language spoken at home *

Do you require an interpreter? *

Interpreter language *

Are you currently experiencing homelessness or at risk of homelessness? *

Please describe details of your financial hardship and circumstances? *

Residential Address *

Street address *

City *

State *

Postcode *

REASON FOR REFERRAL

Tell us why you would like to be referred to this program : (Please include any information which may be useful as background information to assist with the referral) *

Function

Project

Stage