Referral Form

Thrive Hubs are community-based, person-centered services dedicated to empowering individuals to achieve their career aspirations and enhance their capacity for employment or further education.

Thrive Hub near you: *

Consent to collect your Information

To help connect you with the right supports, we collect some basic information about you. Thrive Hubs and other Brotherhood of St. Laurence (BSL) teams keep a record in our system and use this information to contact you, understand your needs, coordinate your referral with other BSL programs that may benefit you, make referrals to other services (if you choose this) and meet reporting requirements set by BSL and our funders. Sometimes, database technical support staff overseas might see your information if there is a problem with the system. We always follow privacy laws.

We may also use de‑identified information (your name, contact information or details that would allow people to know it is you removed) to improve our programs, measure and report our impact, provide more reports to funders or conduct research. These may be shared publicly (published), but no one will be able to know it is you.

You can change your mind at any time, unless we are required by law to keep certain information or need it to ensure essential support continues.

You can contact us to ask questions or tell us you change your mind at:

Thrivehubseymour@bsl.org.au

ThriveHubYarra@bsl.org.au

ThriveHubHume@bsl.org.au

thrivehubfmp@bsl.org.au

We keep your information safe and confidential. You can read our full Privacy Policy here: https://www.bsl.org.au/privacy-policy/

By submitting this form, you agree that we can use your information in these ways, unless you tell us otherwise.

Yes, I agree that BSL can collect and store my information securely to use it to support me, and for reporting on and measuring our impact. *

Yes, I agree that my deidentified information (i.e. this will not include my name, contact information or details that would allow people to know it is me) can be used for broader research, reports and publication. (optional)

Or call at this number to talk to someone at the program:

1300 875 002

1300 875 004

1300 875 048

1300 875 791

We need your consent to collect the information and record your interest in the Thrive Hubs Programs or refer you to another services/partner organisation. If you do not prefer to give us the consent, please click next.

Referral mode *

Self-referral3rd party (friend/family, other organisation/provider)Internal

A member of the Thrive hubs team will be in contact within 2 business days.

Program you work at: *

Organization name: *

Contact person name: *

Contact number: *

Email *

I received a verbal/written consent from the participant. *

Where did you hear about us? *

Where did you hear about us - Other: *

Please specify the service provider: *

Your personal details:

First Name *

Last Name *

Year of Birth *

Month of Birth *

Day of Birth

What is your gender identity: *

MaleFemalePrefer to self-describe

Gender Identity - Self describe:

What is your email? *

What is your Phone Number? *

Preferred method of contact *

Do you need an Interpreter?

Yes (Please specify language)NoPrefer not to say

Which language could you receive interpretation?

Suburb *

Post Code *

Residency status *

Other residency status *

Country of birth? *

Date of Arrival *

Visa type *

Other visa type *

Are you currently working/employed? *

YesNo

Are you currently seeking employment? *

YesNo

Are you currently studying? *

YesNo

How many hours a week are you working? *

What part of the program are you most interested in?

Other kind of support - Please specify:

Additional Comments

Closing section

Preferred contact time – you can select multiple options *

9:00 AM - 12:00 AM12:00 M - 3:00 PM 3:00 PM - 5:00 PMAny time