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Family Support Program Referral Form

For caseworkers and support services. Use this form to refer a family to our Family Support Program for whitegoods, furniture and household essentials. Support is always free to the family.

Referrals are assessed case by case, and our team will contact you about next steps. Questions first? Email info@houseofsadaqa.org.au.

Enquiries: info@houseofsadaqa.org.au

Referrer – Name(Required)
Email(Required)

Client Details

Name(Required)
Date of Birth(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: 128 MB.
    Please provide any documents you have available.

    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.
    Consent & Declaration(Required)