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Independent Advocacy in the Tropics Inc

Service Request Form

Service Request Form WORD - PDF

PLEASE USE 1 FORM PER PERSON
ENSURE YOU ENTER CORRECT CONTACT DETAILS

SERVICE REQUEST FORM

PLEASE USE 1 FORM PER PERSON ENSURE YOU ENTER CORRECT CONTACT DETAILS


SECTION A – DETAILS OF PERSON REQUIRING ASSISTANCE



Is there a Public Guardian Appointed?
Is there a Power of Attorney or Enduring Power of Attorney?
Is the Public Trust appointed for financial management?

SECTION B – DETAILS OF OTHER PARTY MAKING REQUEST

Does the person know and understand and consent to you making this referral?

SERVICE REQUEST PROCESS

You will be contacted within ten (10) business days by the Intake Officer who will review the request, conduct an eligibility assessment and

discuss your options.

We may provide you self‐advocacy assistance or link you to an alternative service and/or organisation that is more suitable.

SECTION C – DESCRIPTION OF ISSUE/S