Referral form

This referral form is for community services or professionals to refer clients to Zahra Foundation Australia's services and programs. You can also use this form to make a self-referral if you would like to access our programs or services yourself.

We ask a number of questions to help us understand how best to support you and ensure your referral reaches the correct team.

Due to high demand, there is currently an 8-week wait for both Financial Counselling and the Pathways to Empowerment program in South Australia.

In New South Wales there is no wait time currently.

We reserve single-session appointments for those in urgent need of financial counselling. Please complete all fields to help us assess if you require an urgent appointment.

Zahra Foundation is not a crisis service - If the client or yourself feels at risk of a serious domestic violence incident you must contact 000 or your local DV crisis service - Can you confirm the client or yourself are not currently at risk of serious harm?

Referrer Details

Name

First Name

Last Name

Organisation

Phone

(###)

###

####

Referee Details

Referral for:

Name

First Name

Last Name

Phone

(###)

###

####

When is a safe time to call:

Is it safe for us to email you:

Is it safe for us to text you:

Program referring into:

Reason for referral:

Any other details:

Are you behind on your rent or mortgage payments?

Are you at risk of homelessness?

Have you received any legal notices about your debts?

Have you been notified of a possible disconnection of your utilities?

If you are seeking group support / program such as Pathways to Empowerment - How motivated are you to find employment or explore further education or training?