Wait List Applications - WESNET Programs

Your Organisation

What is the name of your organisation?*

What is the website of your organisation?*

What is your organisation's ABN?*

My organisation is:*

Select all that apply.

Not-for-profit
Registered with the Australian Charities and Not-for-profits Commission (ACNC)
Public Benevolent Institution
Other

Please describe your organisation

In which State or Territory is your organisation based?*

Your Contact Person

Who is the best person for us to contact about this application?*

First Last

Email address*

Phone number*

Eligibility for Safe Connections program

Does your organisation provide frontline services?*

Yes
No

Are you a specialist women's or generalist service?*

Specialist service for women experiencing gender based violence
Generalist service that has clients who are women that may be experiencing gender based violence
None of the above

Please describe the service(s) your organisation provides to women experiencing gender based violence. Please specify the program or service in which you would use Safe Connections phones.*

We use this information to help us understand the context in which you intend to give Safe Connections phones to your clients.

Suburb and postcodes of your locations where you would like to make Safe Connections phones available*

e.g. Melbourne 3000

Does your service or program have a risk assessment and safety planning process to inform the provision of services to women experiencing gender based violence?*

Yes
No
I'm not sure what this means

How many phones do you estimate your program or service needs for women experiencing gender based violence, on average, per month?*

Safe Connections 2.0

Waiting List Application

Your Organisation

Your Contact Person

Eligibility for Safe Connections program