Family Support Program Referral Form

Enquiries: info@houseofsadaqa.org.au

Referrer – Name(Required)
Email(Required)

Client Details

Name(Required)
Address(Required)
Country of Origin
Gender
Marital Status
Briefly provide details of client's circumstances (Pick more than 1 if applicable)(Required)

Client Essential Requirements

Please select from the following list according to client needs
Items Required(Required)
Please use extra comments below for quantities or other items not listed.
Do you need multiples of any of the above items or specify a size.
Do you currently have accommodation?
Do you believe you may be eligible for Zakat?
Do you identify with a particular religious faith or spiritual practice? (This helps us provide culturally appropriate support)
Drop files here or
Max. file size: 20 MB.

    Terms & Conditions (To be discussed with the client)

    • House of Sadaqa provides assistance based on availability of resources and eligibility criteria. • We reserve the right to assess and prioritize cases based on urgency and need. • Clients must ensure they or a designated individual are available to receive deliveries. • House of Sadaqa is not responsible for removal of any unwanted or existing household items. • All items provided are donations and not for resale. • Misrepresentation of circumstances may result in discontinuation of support. • House of Sadaqa may contact the referrer or client for follow-up and impact assessment. • Acceptance of assistance indicates agreement to these terms.

    Referral Application Fee (For organisations only)

    A $100 admin cost applies to each approved referral to cover processing, assessment, and logistics. This helps ensure we can continue providing essential support efficiently.
    Consent & Declaration(Required)