Preferred Name

Pronouns She/HerHe/HimThey/ThemShe/TheyHe/They

Legal Name (required)

We understand this can be sensitive information, it will only be used where legally required.

For legal purposes do you identify as LGBTQIA+ or the parent of a child who identifies as such?
YesNoParent of childUnsure

If unsure about the above, please contact us via phone.
What does LGBTQIA+ mean?

Income Negative incomeNil income$1–199 weekly ($1–$10,399 yearly)$200–$299 weekly ($10,400–$15,599 yearly)$300–$399 weekly ($15,600–$20,799 yearly)$400–$599 weekly ($20,800–$31,199 yearly)$600–$799 weekly ($31,200–$41,599 yearly)$800–$999 weekly ($41,600–$51,999 yearly)$1000–$1249 weekly ($52,000–$64,999 yearly)$1250–$1499 weekly ($65,000–$77,999 yearly)$1500–$1999 weekly ($78,000–$103,999 yearly)$2000 or more weekly ($104,000 or more yearly)

Postcode

Date of Birth

Phone Number

How can we safely contact you?

PhoneEmailTextAll methods are safe

Email Address

About You

Are you at risk of homelessness? YesNoCurrently Homeless

Do you identify as Aboriginal or Torres Strait Islander? NoYes - AboriginalYes - Torres Strait IslanderYes - bothUnknown

What is your visa status? CitizenPermanent ResidentBridging VisaFamily/Partner VisaHumanitarian/Protection VisaStudent VisaTemporary/Skilled Worker VisaNew Zealand CitizenSpecial Category VisaTemporary Graduate VisaUnknown/Other

The legal issue

What is the issue?Criminal ChargesFinesDebtEmploymentFamily lawDiscriminationOther

Which service are you trying to reachLGBTQI+ Legal ServiceTrans and Gender Diverse Legal ServiceSex Worker Legal ServiceEmployment RightsUnsure/Other

Are you a sex worker, or does the issue relate to sex work YesNoUnsure

Description

Note: Please read our privacy policy for more information on how your details will be managed.