AGENCY REFERRAL FORM

All the information given to IMMIGRATION HUB SERVICES is confidential and IMMIGRATION HUB SERVICES will not share it with anyone without the client’s consent unless permitted or required by law. Information provided to us about child harm or child sexual abuse may have to be reported to the authorities.

Thank you for your interest in registering, we’re excited to have you with us this year!

Please complete all pages of this form and email it to admin@rails.org.au with:

Copy of client’s passport or Immicard
Visa grant notice, if applicable
Emails or letters from the Department of Home Affairs or the Administrative Appeals Tribunal, if applicable
Client authority SIGNED BY THE CLIENT for RAILS to share information with the referrer, if you would like us to be able to update you about this referral (see page 4)

It is very important that you send IMMIGRATION HUB SERVICES the documents above, if the client has them. They help us understand the urgency of the referred matter and what IMMIGRATION HUB SERVICES can do to assist

A. Referrer

Organisation:

Referrer’s full name:

Telephone:

Email address:

Availability (working days and times):

B. Client’s Information

Personal Details:

First name:

Surname:

Date of birth:

Gender:

Contact Details:

Telephone:

Email address:

Residential address:

Post code:

Homelessness status:

Please advise if we should be aware of safety issues and times to contact / not contact the client:

Please advise if there is any time, between Monday and Friday, from 9am to 5pm, at which the client would prefer not to be called (for reasons other than safety concerns). IMMIGRATION HUB SERVICES will try to contact the client outside of these times, but cannot guarantee that this will be possible:

Language:

Language spoken at home:

Do they need an English interpreter?:

Spoken English:

Written English:

Disability status:

Do they identify as? :

C. Description of Client’s Matter:

Country of birth:

Date of arrival in Australia:

Current visa type:

Visa expiry date:

Is this matter urgent?:

If yes, is there a deadline? Date:

If yes, nature of urgency / deadline:

What assistance does the client request from IMMIGRATION HUB SERVICES?

Referral